MGMA members described capping Medicare Advantage contracts and favoring commercial patients, while one Texas practice leader reluctantly called Medicare her best payer.
News|Videos|December 10, 2024
Value-based payment: Sources and a summary
Author(s)Richard Payerchin
Key Takeaways
- Primary care physicians endorse value-based care goals but hesitate to participate in value-based payment models.
- Direct engagement with physicians is crucial to understanding their reluctance to join these models.
A physician researcher discusses why primary care physicians do not participate in value-based payment models.
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Primary care physicians are enthusiastic about the goals of value-based
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Related to this article
EBRI data show employer plans pay hospital outpatient departments about twice what physician offices receive for the same physician-administered drugs, and the commercial market has barely begun to address the gap.
From a same-day payment cut to AI-run prior authorization in traditional Medicare, MGMA's government affairs team laid out what Washington has in store for physicians next year.
The American Medical Association and five specialty societies say casting AI as smarter than physicians diminishes their expertise, a day after the health secretary praised AI second opinions.
At an MGMA Government Affairs town hall, attendees raised extrapolated audits, employer plans beyond state reach and denials with no reason codes.
A fallback version would make insurers prove upcoding, notify physicians and limit downcoding to 90 days.
Acting chief executive Akash Madiah credited practice leaders for outcomes patients never see, and the session's emcee offered a patient's account of two years of doctor visits.
MGMA's government affairs staff walked through the fee schedule, value-based care, prior authorization, Medicaid and the year-end fight in Congress.
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