Medicare’s New Payment Plan Gives Doctors Pause

The idea is to reduce the amount of time doctors have to spend at the keyboard, but some worry about unintended consequences.

CMS recently unveiled a plan that would affect about 40% of payments made to physicians by Medicare. The plan, which is open for public comment until September, combines the forms now needed for reimbursement for each doctor’s appointment into one form by charging a flat fee for many visits. 

The idea is that by reducing paperwork, doctors will have more time to treat patients. CMS Administrator Seema Verma previewed the plan to doctors earlier this month in a letter in which she wrote: “We believe you should be able to focus on delivering care to patients, not sitting in front of a computer screen.”

Sounds simple, right? But it also would pay physicians less per visit and that’s raised some hackles. Kaiser Health News (KHN) talked to Angus Worthing, MD, a rheumatologist who said that he would only save about one or two minutes per patient under the new system, to which CMS’s Chief Medical Officer Kate Goodrich, MD, responded that “saving one to two minutes per patient adds up pretty quickly over time.”

Other physicians say that the plan would encourage seeing fewer Medicare patients. But CMS says that the plan includes an “add-on” payment of $67 per appointment to help mitigate against that. That will mean more documentation but time at the computer would still be reduced, CMS officials say. 

Other doctors worry that the new system might encourage physicians to actually see more patients for shorter visits. There’s also some concern that the payment system might be adopted by commercial insurance plans. “If the Medicare payment changes take effect, private insurers might follow suit, in part because it’s easier for all insurers to use common billing procedures,” KHN reports.