Medicare Physician Fee Schedule should be part of value-based payment, analysis argues


CMS should no longer separate management of the Medicare Physician Fee Schedule and Alternative Payment Models, according to a policy brief published in Health Affairs.

While APMs are aimed at addressing fee-for-service inefficiencies by delivering value-based healthcare, the policy brief's authors argue that the models are being built and tested on fee-for-service bases — in particular, the Medicare Physician Fee Schedule.

The Medicare Physician Fee Schedule also underlies fee schedules used by Medicaid programs and private health plans. As healthcare moves more and more to value-based payments, the authors claim the underlying fee-for-service architecture must change.

"The prevailing policy dichotomy between volume- and value-based payment is flawed. Most physicians and other health professionals continue to receive most of their payment via fee schedules," the authors said. "Like APMs, fee schedules can produce more or less value by influencing how clinicians spend their time and the mix of services provided to patients. The Medicare Physician Fee Schedule could be part of the move to value-based payment if relative fees were prudently modified to achieve value-based objectives."

For the full analysis, click here.

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