Why the New Public Option is Better for Physicians
The thing to keep an eye on is the negotiation requirements—this may be how CMS drives payment reform. The legislation states that "the Secretary may utilize innovative payment mechanisms and policies to determine payments for items and services under the public health insurance option." It lists examples like the patient-centered medical home, accountable care organizations, value-based purchasing, bundling of services, differential payment rates, performance- or utilization-based payments, partial capitation, and direct contracting.
Private insurers are already including some of these mechanisms in contracts, and both sectors will probably start adding more quality and performance caveats to contracts in the future. I've talked to many physician groups that leverage quality data to improve their overall rates already, and many private payers are exploring pay for performance and other innovative methods for improving quality and reducing costs.
Sure, there's still a decent chance that the public option doesn't make it through at all. Or if it does, it may be tied to a trigger or opt-out clause that waters it down. But physicians concerned about the financial impact of such an option should take comfort in the fact that whatever makes it through won't likely be tied to Medicare rates.
That's no small victory.
Note: You can sign up to receive HealthLeaders Media PhysicianLeaders, a free weekly e-newsletter that features the top physician business headlines of the week from leading news sources.
Elyas Bakhtiari is a freelance editor for HealthLeaders Media.
- Half of All Primary Care, Internal Medicine Jobs Unfilled in 2013
- How Digital Strategy Shapes Patient Engagement at Boston Children's Hospital
- CFO Exchange: Smartphones Poised to Disrupt Healthcare, Says Topol
- CNO on Hospital Redesign: 'You Can't Over-Communicate'
- Some Cancer Hospitals' Quality Data Will Soon Be Public
- CA Powers Up $80M HIE to 'Create Value in the Data'
- TJC Warns Hospitals of Deadly Medical Tubing Mistakes
- 3 Traits Personality Assessments Can't Reveal
- PA Ranks See 'Phenomenal Growth,' Lack of Diversity
- Carondelet to Pay $35M to Settle Fraud Allegations