Medicare Payment Policy

4-1
4–1
FIguRe
40
35
30
25
20
15
10
5
Annual increase in outlays (in billions of dollars) FIGURE
0
2013
2014
Note: CBO (Congressional Budget Office).
Source: Congressional Budget Office 2012.
CBo estimates of increase in outlays under freeze in payment updates
for services of physicians and other health professionals, 2013–2022
2015
program should encourage movement from FFS into risk- • The physician fee schedule must be rebalanced to
bearing Note: Note accountable and Source are care in InDesign. organizations (ACOs) by creating achieve equity of payments between primary care and
greater opportunities for shared savings. Fourth, repeal
Source:
of the SGR should be fiscally responsible. In exercising
its prerogatives, the Congress could decide to fund repeal
entirely within Medicare, or it could consider other options.
•
other services.
Pressure on FFS must encourage movement toward
new payment models and delivery systems.
While the Commission has not recommended funding
• Repeal of the SGR must be fiscally responsible.
repeal entirely Notes within about Medicare, this doing graph: so would require
spending offsets across Medicare. Specifically, in addition In order to assist the Congress, the Commission outlined
to a freeze • Data in the is payment in the rates datasheet. for primary Make care updates and a in the a datasheet. menu of options that could constrain the cost of repeal
reduction • in WATCH payment FOR rates for GLITCHY all other RESETS physicians, WHEN it would YOU (e.g., UPDATE conversion-factor DATA!!!! reductions) and a set of offsets
include
•
offsets
The
in
column
other provider
totals were
sectors—such
added manually.
as hospital, (e.g., provider reductions and increases in beneficiary cost
skilled nursing facility, home health, and others—and sharing). While the Commission has not endorsed every
higher out-of-pocket • I had to manually costs for beneficiaries. draw tick marks and axis lines one because of these items they individually kept resetting or as when a package, I changed they do any data.
• I can’t delete the legend, so I’ll just have to crop exceed it out the in likely InDesign. cost of SGR repeal. Nonetheless, this
Further details on the Commission’s position on repeal
list illustrates that funding repeal entirely within Medicare
of the SGR • Use are in direct our October selection 2011 tool letter. to select However, items we for modification. Otherwise if you use the black selection tool, they
would present the Congress with some difficult choices.
emphasize default several when points: you change the data.
If, however, the Congress decides that all of the cost will
•
• Use paragraph styles (and object styles) to format.
Repeal is urgent. Delay will not provide more favorable
not be borne within Medicare, it could enact smaller
options, • Data and repeal was from: becomes R:\Groups\MGA\data more costly over time. book conversion-factor 2007\data book reductions, 2007 fewer chp1 provider reductions,
and smaller increases in beneficiary cost sharing. The
• Beneficiary access must be preserved.
Congress could also choose to phase in such changes by,
for example, ramping up conversion-factor reductions
80 Physician and other health professional services: Assessing payment adequacy and updating payments
2016
2017
2018
2019
2020
CBO estimates....
2021
2022