The Trump administration has made waves with a slew of proposed Medicare changes since coming to power in 2016. The proposals come after several failures to repeal and replace the Affordable Care Act, something the President promised to do since early into his campaign. With the Affordable Care Act off the table for now, changes to Medicare are next on the administration’s docket. Here are four proposed changes to Medicare.
1. Pay doctors a flat fee
One of the more controversial changes to Medicare, this move would pay doctors who accept Medicare a flat fee. Medicare providers currently charge patients based on the level of care received during their appointment, but this proposal would change that. Instead, it would pay doctors a flat fee no matter what kind of appointment the patient had.
The logic is to remove the burden of administrative work from the doctors in order to allow them to spend more time with patients. However, this proposal has been met with great resistance. Many health experts fear that it would underpay doctors, increase the risk of fraudulent billing, and decrease the number of doctors willing to accept Medicare patients.
2. Add step therapy protocol to Medicare Advantage drug plans
Another controversial move of the administration is to add step therapy protocol to Medicare Advantage drug plans. Step therapy protocol means patients would need to try cheaper versions of medication before trying more expensive versions. Drugs under the step therapy protocol are usually physician-administered drugs covered under Part B.
But the catch is that there often aren’t cheaper versions of these drugs available. Even if they are, they might not be the best drug available for these patients, who are usually Medicare’s sickest beneficiaries with complex conditions like metastatic cancer.
Although step therapy has been proven to decrease drug costs, experts fear that this “fail first” protocol will compromise the health of patients, place the drug plan directly between the patient and doctor, and deter people from buying Medicare Advantage drug plans.
3. Limit payments to doctor offices on hospital grounds
Medicare pays more for patients seen by a doctor whose office is located in a hospital or hospital-owned facility. Medicare’s proposal is to pay a flat fee for “site-neutral” appointments, meaning Medicare would pay the same amount no matter where a patient is seen.
This move could save Medicare an estimated $760 million in 2019 and possibly lower copays by about $10. However, some worry that it could underserve some of Medicare’s sickest patients with complex conditions like cancer and heart failure. It could also impede patients’ access to care.
4. Increase accountability for Accountable Care Organizations
Medicare Accountable Care Organizations (ACOs) were established by the Affordable Care Act. ACOs are composed of groups of doctors, hospitals, and other healthcare providers who voluntarily work together to coordinate patient care and reduce healthcare costs. They share accountability for savings they achieve for Medicare, but the Trump administration wants to make sure they’re responsible for losses they generate as well.
As of right now, 82 percent of Medicare ACOs are no-risk, meaning they won’t lose any money if they fail to save Medicare the amount of money they aimed to save. The other 18 percent of ACOs receive more savings, but they are also at risk of losing money if they don’t meet their savings goals. This small percentage of ACOs has been more successful at saving Medicare money because there is more on the line. The Trump administration wants to phase out no-risk ACOs by 2020.
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