Will Chiropractors Benefit from Medicare's Proposed Reformations?

May 7th, 2018 - Wyn Staheli, Director of Research
Categories:   Chiropractic   Medicare  
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Recently, Medicare's Innovation Center released an informal Request for Information (RFI) seeking input on several different system reformation proposals. As the market moves towards value based payment systems, new models are being sought to both reduce costs and increase quality. This article outlines some of the ideas presented in the RFI which we find of particular interest to doctors of chiropractic.

Expanded Opportunities for Participation in Advanced APMs

Alternative Payment Models have been picking up some steam since MACRA began in 2015. CMS must be seeing positive results because they are trying to figure out ways to further encourage provider participation. This could be an excellent opportunity for chiropractic care to expand by participation in these models.

Consumer-Directed Care & Market-Based Innovation Models 

Empowering consumers to make choices on how their healthcare dollars are spent can yield more bang for the buck. There were several ideas presented in this portion. One very interesting idea is allowing beneficiaries to contract directly with healthcare providers to come up with new payment arrangements such as bundled care. While some say this is a great idea, others are concerned that it opens the door to potential fraud. CLICK HERE to read an article in Modern Healthcare about this idea of allowing providers to bill patients directly.

Medicare Advantage (MA) Innovation Models 

CMS is currently implementing "the Medicare Advantage Value-Based Insurance Design (VBID) model, that provides benefit design flexibility to incentivize beneficiaries to choose high-value services; but this model could be modified to provide more flexibility to MA plans and potentially add additional states." They are looking for ideas for other alternatives as well.

Since chiropractic care has been proven to be an excellent model for treating spinal pain with lower costs and better outcomes, this is another area which could be beneficial. Let CMS know how you can benefit MA models.

Program Integrity

As always, CMS is looking for ways to further reduce fraud, waste, and abuse in government healthcare programs. They stated that they are trying to find a balance between patient care and the increased physician workload and "effectiveness of the review." We are glad that they recognize the administrative burdens which these program integrity programs have placed on providers. Hopefully they can find ways to make reviews less burdensome.

Even though we know that reviews are burdensome, we'd like to take this moment to remind everyone that quality documentation is one of the best ways to demonstrate compliance.

Summary

If you have good ideas, now is the time to submit them to CMS. Let them know what you think. CLICK HERE to go the CMS Initiatives website.

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