Researchers explore its history, reasons behind
calls for reform, and provide recommendations for
improvements
LANSING, Mich.,
May 7,
2024 /PRNewswire/ -- Today, Health Management
Associates (HMA) released a new white paper, "Medicare Physician
Fee Schedule Reform: Structural Topics and Recommendations to
Strengthen the System for the Future." It provides an in-depth
analysis of the Medicare Physician Fee Schedule, including the
history of its implementation, stakeholder perspectives on reform,
major structural issues, and recommendations for improving the
$90-plus billion payment system.
Recent years have witnessed a growing bipartisan call to reform
how Medicare reimburses for physician and other health professional
services. A wide array of stakeholders assert that the current
system—the Medicare Physician Fee Schedule (PFS)—is misaligned with
today's practice patterns and market dynamics. Many constituencies
maintain that the PFS is insufficiently updated, embeds known
pricing distortions, and does not appropriately effectuate
value-based care principles. Although a considerable number of
legislative and regulatory changes have been implemented to refine
and modernize the system, the PFS has never been subject to a major
statutory overhaul that would comprehensively address pressing
issues.
HMA studied these issues with support from Arnold Ventures in
"Medicare Physician Fee Schedule Reform: Structural Topics and
Recommendations to Strengthen the System for the Future." HMA's
white paper is an accessible primer on the PFS and key moments that
led to the current policy situation. The white paper describes
structural topics in the PFS that raise concern or prompt calls for
change, provides context on the history and progress of the payment
system and highlights stakeholder perspectives on reform.
Authors also include a series of recommendations that the
Centers for Medicare and Medicaid Services could implement without
Congressional action to help improve payment accuracy, further the
adoption of alternative payment models and help strengthen the
system for the future. The recommendations highlight areas that
prioritize actionable steps, prompt idea generation, and encourage
process improvement within the PFS.
For accessible background and context on the PFS and why
the stakeholder community is calling for reforms to the fee
schedule, download here.
View an electronic timeline of key policy developments and
highlights of topics related to the PFS since implementation
in 1992 here.
About HMA
Founded in 1985, HMA is an independent,
national research and consulting firm specializing in healthcare
and human services policy, programs, financing, and evaluation.
Clients include government, public and private providers, health
systems, health plans, community-based organizations, institutional
investors, foundations, and associations. Leavitt Partners, an HMA
Company has been at the forefront of navigating change in
healthcare for over a decade and works at the intersection of
government and health care, helping clients stay one step ahead of
the influences impacting the industry, including economic, market,
delivery system, public policy, and political developments. HMA has
offices in more than 30 locations across the country and over 700
multidisciplinary consultants coast to coast. Learn more about HMA
at healthmanagement.com, or on LinkedIn and X.
About Arnold Ventures
Arnold Ventures is a
philanthropy dedicated to tackling some of the most pressing
problems in the United States. It
is a team of more than 120 subject-matter experts headquartered in
Houston with offices in
New York and Washington, D.C. It works in five key issue
areas: Criminal Justice, Education, Health, Infrastructure, and
Public Finance. Its work is guided by evidence-based policy,
research, and advocacy.
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SOURCE Health Management Associates