Medicare payments not covering care costs, many physician practices say

Many physician practices are struggling to cover care delivery costs with current Medicare reimbursement, according to a poll conducted through Medical Group Management Association Stat

The Jan. 15 poll asked practices about their 2019 Medicare payment rates compared to the cost to deliver care. Sixty-seven percent of the eligible 478 poll respondents said their practice's payments fall below the cost of delivering care, while only 16 percent said payment rates are above those costs. Seventeen percent of respondents said payment rates are equal to the cost to deliver care to beneficiaries.

Because Medicare reimbursement falls below care delivery costs for many practices, practices often rely on reimbursement from private insurance companies to ensure expenses are taken care of, said MGMA government affairs representatives in a commentary piece about the poll.

"As medical practices transition toward a value-based payment environment, fee-for-service does not need to be abandoned entirely, but it does need to be updated appropriately," they wrote. "Even if a payment system provides the right incentives, if the underlying reimbursement rates are too low, the system is not sustainable for physicians to continue providing high-value care."

Read the full commentary piece here.


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