HHS, CMS, RVUs, APMs, & Burnout

HM Epstein hmepstein at GMAIL.COM
Tue Aug 23 22:19:09 UTC 2016

I need some expert help, here. If you comment, please let me know if you
are willing to be quoted or if you prefer to just help out with "deep
background". I won't quote anyone until I've contacted you personally to
ensure you are okay with it. I respect the open dialogue here and don't
wish to constrain it in any way.

I'm working on an article about the causal relationship between physician
burnout, and Dx and safety errors. There's plenty of data connecting the
two. We also have seen lots of studies explaining why physician burnout is
occurring at a faster rate. Reimbursement via RVUs has been blamed as one
of the key reasons. [BTW, I highly recommend Anne Lippin's blog posts
on physician
burnout <http://annelippin.com/blog/2016/08/08/laying-down-my-stethoscope/>
and stories from the front lines

What I don't fully understand are two elements:

   1. Do you think that the changes in how Medicare practitioners will be
   reimbursed will help reduce burnout by changing the focus from number of
   patients seen to quality of care? Will the change in bookkeeping change how
   PCPs, hospitalists, intensivists and emergency dept. physicians are
   evaluated? And how are those changes being judged by the CMS and do you
   think the criteria will work?

   2. In March, HHS announced
   they have achieved their goals of tying 30 percent of Medicare payments to
   quality ahead of schedule. I assumed that they were trying to reduce the
   number of organizations reimbursed through RVUs (relative value units) but
   in reading the original January 2015 announcement
   they said "HHS has set a goal of tying 30 percent of *traditional, or
   fee-for-service*, Medicare payments to quality or value through
   alternative payment models, such as Accountable Care Organizations (ACOs)
   or bundled payment arrangements by the end of 2016, and tying 50 percent of
   payments to these models by the end of 2018.  HHS also set a goal of tying
   85 percent of *all traditional Medicare payments* to quality or value by
   2016 and 90 percent by 2018 through programs such as the Hospital Value
   Based Purchasing and the Hospital Readmissions Reduction Programs."

   So, is HHS calling the RVU reimbursement model "traditional" Medicare
   payments? Or is this program focused on the old fee-for-service model that
   preceded the RVU model?

Thank you in advance for your thoughts and comments.

@hmepstein <https://twitter.com/hmepstein>
Mobile: 914-522-2116

Moderator: David Meyers, Board Member, Society to Improve Diagnosis in Medicine

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