Medicare Compliance & Reimbursement

Medicare could soon single out expensive doctors, bundle more services.

Warning: Drastic moves to slash at the growth of physician spending could be on the way. A March 10 hearing of the House Ways & Means Health Subcommittee considered some fixes, including:

· Putting one physician on the spot for all the care each patient needs for a particular "episode" of care. It would be easy to group most physician services into individual "episodes" and then give the responsible physician a "score," claimed Glenn Hackbarth, chair of the Medicare Payment Advisory Commission (MedPAC).

Hospitals and other providers already receive Medicare payments based on "episodes," and this keeps spending under control, claimed Robert Berenson, a senior fellow with the Urban Institute.

Physician groups, including the American Academy of Family Physicians and the American College of Physicians, encouraged Congress to try the "patient-centered medical home." This way, your doctor could receive a monthly fee for managing your patients' long-term illnesses, and in return your doctor would have to coordinate all of the patients' care.

· Bundling more services into procedures, the way pre-op and post-op visits are bundled now. The only drawback to this approach would be that doctors could refer their patients to other doctors for the bundled services, Hackbarth said.

· Giving doctors a report card to let them know how many services they're providing per patient, compared to other local doctors in their specialty. "Many physicians are highly motivated individuals who strive for excellence and peer approval," said Hackbarth. Physicians who were identified as money-wasters "may respond by reducing the intensity of their practice."

· Imposing standards for imaging services, and maybe also for other physician services.

· Fixing distorted prices for services like imaging scans, which get cheaper the more of them your practice does, Berenson said.

Medicare payments for physician services have gone up more than 9 percent a year since 2000, Hackbarth noted.