Medicare's Overhaul of Physician Payments

Gain an understanding of the updated payment changes reflective in the new year within Medicare restructured specifically for physicians.

Medicare is expected to impose far-reaching changes in how physicians are paid starting in 2019. The Centers for Medicare & Medicaid Services (CMS) has proposed the first major re-do in almost 20 years in how evaluation and management (E&M) services will be paid - these are an important part of billings for almost all specialties. CMS has proposed to simplify the E&M payment structure in ways that will, if adopted as proposed, create winners and loser and be disruptive for many specialties. This rule also contains various changes in the Quality Payment Program (QPP) that will affect physicians that do not participate in Advanced Alternative Payment Mechanisms, which include certain Accountable Care Organizations. CMS has also proposed various changes to Medicare's ACO program; the proposals have been criticized as 'raising the bar' for ACOs, making this alternative more difficult for physicians to use to share in savings or avoid payment cuts. Physician practices will thus have to weigh a revised set of options as they seek to avoid payment reductions and secure higher payments for their services. This topic will explore the changes CMS actually adopts for implementation in 2019 and equip participants to understand and react appropriately to these changes.