3 predictions regarding MIPS and Medicare changes

I predict that within the next two to five years we will be seeing two major trends happening within our healthcare system and they will both be the result of the changes Medicare has been making towards the reimbursement system that they think will be for the better, but in actuality will create these problems. Anybody with a brain can see it coming, if they stop to think about it. Unfortunately our federal government does NOT require any brains to get a job.

With MIPS and their other changes, physicians will be “graded” and either rewarded or penalized percentage points affecting reimbursement rates. For example, if a treatment was reimbursed at $100, a physician who rated at the top by the 2019 planned point structure could earn up to another +7% bonus, meaning they could earn $107. If they were rated as a poor performer they may get the lower -7% deduction and earn only $93. These all add up over time to big money for clinics.

Another idiotic assumption by the government is that this reward-penalty system will not cost anything extra, as they plan to “take” from the losers to “give” to the winners. That’s assuming a perfect 50-50 split on rewards and penalties. There is no way that is going to happen. They will have to “fudge” their rating scores and more, and will also apply some type of “adjustment” rates to make it come out without any losses. The government has never been very good at that as time has repeatedly shown over and over again.

There are certain exemptions for smaller clinics and such and that will likely lead to changes at those clinics in the dismissal of poorer performing providers who do not earn the extra bonus points. So my first prediction is that physicians will be fired for poor performance that costs the clinics the extra revenue they desire. Medicare says that performance percentage will follow the physician if they leave that clinic, meaning that their next job may depend on their Medicare rating. A clinic will likely choose a positive point producer over a negative point loser to add to their practice.

The performance of the physician is based on their treatment and application of guidelines towards the different medical problems of each of their patients. If a patient does well by their standards, the physician earn bonus points. If the patient does not, even if it is due to the patient being non-compliant with recommended therapies, the physician still get docked and loses points. It won’t take long before clinics realize this and look for the easy solutions to this problem.

So my second prediction is this: complicated or troublesome or non-compliant Medicare patients WILL be fired, for whatever reason they can find or create to justify such action. By getting rid of this “point losing” patient, it will improve the clinic’s overall score. Then this patient will also have trouble finding a new Medicare provider because those clinics will also be screening such patients as to whether or not they will be “bonus point” patients or “point losing” patients. Which one do you think they will accept into their practices?

My end-resulting third prediction is this: more and more physicians will just quit Medicare to avoid dealing with this mismanaged system. The Direct Primary Care trend will continue to grow thanks to the stupidity and short-sightedness of the Medicare system and more and more senior citizens will be left without a healthcare provider. I would demand then, that the government-funded health systems across the country then start providing free health care to these senior citizens, because these clinics raked in millions of dollars year after year in bonus profits while providing shoddy care and fraudulent billings to reap their ill-gotten gains.