Tuesday, February 28, 2012

Medicare Reimbursement Policies

The Medicare Payment Advisory Commission (MedPAC), an independent agency that advises Congress on Medicare issues, recently voted to recommend to Congress that reimbursement for non-emergent, outpatient hospital visits be equalized with the reimbursement for the same service physician's office.

Lyle Swenson, M.D.,
2011-2012 MMA President

The MedPAC Trustees acknowledged that Medicare pays about 80 percent more for an outpatient visit at a hospital than for the same type of visit at a physician’s office.  With the increased hiring of physicians by hospitals, this is thought to be costing Medicare a significant amount of money.  MedPAC Chairman Glenn Hackbarth says that “Medicare needs to move, over time, to paying the same amount for the same service, regardless of the provider type”.
For both Medicare and commercial insurers, the reimbursement disparities between hospital based and office based outpatient services has been apparent for many years.  Despite previous efforts to bring the light of day to this issue, it is not well known in the medical community, and is not understood at all by the public.  The MMA House of Delegates has addressed this topic, but there has not been a clear consensus on how to address these disparities.
This should be an issue where physicians come together to promote clarity, honesty, and fairness.  It seems now that MedPAC, through their recommendations, may promote a wider understanding of these disparities, and possibly foster a broader discussion of reimbursement policies and a more logical, equitable approach to reimbursement for outpatient services in the future.

1 comment:

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