Medicare ’s Programs Should Compete

Over the past two decades, Medicare has evolved into three separate programs or payment systems: fee-for-service (FFS), sometimes termed traditional Medicare; Medicare Advantage (MA); and the Medicare Shared Savings Program (MSSP), or accountable care organizations (ACOs). Regulations governing these three programs differ substantially. For example, participating plans, physicians, and other eligible clinicians are reimbursed and financially incented in different ways. Under the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015, FFS providers and some ACOs can earn an annual bonus that would increase their reimbursements by a certain percentage. Other ACOs can earn a percentage of shared savings and potentially an additional alternative payment model (APM) 5 percent bonus based on their previous year’s total Part B billing if they meet certain minimum billing and beneficiary thresholds. MA plans are potentially eligible for the same 5 percent MACRA bonus although their financial benchmarks are calculated differently. Because of this, annual rule making for the Centers for Medicare and Medicaid Services (CMS) has become an increasingly exigent exercise. The agency, tasked with appropriately paying for care and quality for a diverse population of 56 million Medicare beneficiaries in a complex $630 billion market, now publishes 17 annual FFS rules as well as rules for the ACO program, rules for MA, rules to implement MACRA’s Quality Payment Program, and frequently...
Source: Health Affairs Blog - Category: Health Management Authors: Tags: Costs and Spending Featured Insurance and Coverage Medicare Payment Policy Accountable Care Organizations AHCA MACRA Medicare Advantage Medicare Shared Savings Program MedPAC Source Type: blogs