delivered state and national presentations on healthcare policy for physicians and policymakers .
If anyone locally can predict the future in an uncertain and constantly changing healthcare environment , he ’ s the one to ask .
Dr . Pittman is clear that although there is a new captain at the helm , the ship will remain heading the direction it was already going : away from the fee-forservice payment model and toward a feefor-value payment model .
“ Trumpcare ” will have little to no impact on how physicians are paid
“ Changes to Obamacare or “ Trumpcare ” won ’ t change anything for my practice , and , frankly , probably not for many physicians ,” Dr . Pittman says . “ A repeal of the ACA won ’ t materially affect most physicians because the way physicians are paid is now codified in the bipartisan , 2015 MACRA law .”
The Medicare Access and CHIP Reauthorization Act of 2015 ( MACRA ) repeals the sustainable growth rate ( SGR ) methodology for determining updates to the Medicare physician fee schedule . This law shifts the paradigm from the traditional fee-for-service model to a feefor-value model .
MACRA changes to Medicare payments took effect on January 1 , 2017 , allowing physicians to choose from two quality metrics : the Merit-based Incentive Payment System ( MIPS ) or Advanced Alternative Payment Models ( APMs ). Medicare payments based on these quality metrics will not be received until 2019 .
Some have alleged that we have a medical ( that is , sick ) care system — a system that waits until we become ill before it kicks into action — instead of a health care system focused on helping us stay healthy .
“ The way we ’ re paid right now is sick care . We wait for someone to get sick and fix them . Under fee-for-value , we ’ re going to be paid based on the value we provide our patients ,” says Dr . Pittman .
Potential changes to come
Dr . Pittman shared a memo from the Florida Medical Association ( FMA )
Director of Health Policy and Innovation , Jarrod Fowler , indicating that the prospect of substantially reshaping the federal health care system for the second time in recent history will also offer unprecedented opportunities to advance changes that benefit Florida ’ s patients and caregivers .
In the memo , it is noted that there is also currently no consensus on the future of Medicaid expansion , which is a crucial component of ACA ’ s major coverage provisions .
Florida chose not to expand Medicaid , but according to the Kaiser Family Foundation , the uninsured rate in Florida has dropped from around 19 % in 2013 to around 13 % in 2015 .
Whether states like Florida that have yet to expand Medicaid eligibility will continue to have that option available , and whether the current eligibility standards and enhanced matching rate for this population will remain the same are two important questions that need to be decided upon . Given that a number of red states have signed onto expanding Medicaid eligibility , including Vice President Mike Pence ’ s home state of Indiana , enacting a proposal that would substantially reduce the funding for the newly eligible Medicaid population may prove politically challenging .
On specific policy ideas , Dr . Pittman offers an important take . At face value , the idea of selling health insurance policies across state lines seems like a good idea , but as Dr . Pittman notes , in politics , what seems like a good idea is often a bad idea .
“ Selling health insurance across state lines is not a good idea because right now , insurance regulation is a state rights issue . FMA fought really hard and won against egregious practices by health insurance companies , but if we allow selling of policies across state lines , all the political gains against health insurance companies will probably go out the door ,” says Dr . Pittman .
At the heart of the health care delivery issue is diversity . A state like Florida is similar in size to many countries . With 20 million people from diverse backgrounds , solutions that fit Floridians may not fit all states . And vice versa , health care solutions that work in Utah may not be ideal in New York .
MACRA is key
Despite all of the theoretical changes , Dr . Pittman notes the key for physicians right now is to pay very close attention to MACRA , specifically , the fee-for-value model of payment .
This is a silver lining in a shifting payment environment . The fee-forvalue concept provides a pathway for physicians to do what ’ s best for patients , lower health care costs , and maintain our integrity as doctors .
“ Commercial payers typically follow whatever Medicare does , and right now , they are like ducks on water quickly putting fee-for-value networks together ,” says Dr . Pittman . “ Local clinically integrated networks like Tampa Bay Integrated Healthcare Network ( TBIH ) have contracts with these large commercial payers and it ’ s important to join a network like this .”
Dr . Pittman equates the future for independent physician as similar to a game of musical chairs . Payers are building networks and physicians are choosing whether or not to join .
“ It ’ s my prediction that in 3-5 years , the music may stop and some doctors will have no patients to care for if they don ’ t start engaging commercial payer fee-forvalue networks .”
While this prediction may seem grim , Dr . Pittman is quick to point out the importance of getting onboard .
“ MACRA and fee-for-value payment models are the cards we ’ ve been dealt . We need to understand how to play , or we will not be in a good position in 3-5 years .”
Issue 1 , 2017 Doctor ’ s Life Tampa Bay 9