HLTH 385 Lecture 13: Lecture 13
21 May 2018
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• There's money that flows from insurers to physician groups, then from those
groups to doctors
• Self referral focuses on how groups pay doctors
• Remember RBRVS system from last lecture (codes attached to each service,
weight assigned to each that determines the payment)
• Responses to payment level ~ changes
o Provide less care
o Provide more care (if you pay physicians less, to make the same amount of
money, they have to work more)
• Geographic adjustment
o Payments that physicians get are based off of geographic area of practice
o High cost area= higher payment
• Could lead to an oversupply of physician in high cost cities rather
than in rural areas
• Payment for cognitive services
o Counseling
o Care coordination
• Division of labor: nurses, physicians assistants
• MIPS: Merit-Based Incentive Payment System
o system for physicians to get bonuses on top of what they're already paid
o Medicare gives them bonuses based on other compensation scheme
measures such as quality, and cost saving
o (How insurers pay physician groups)
o NEXT BIG THING ON THE HORIZON FOR MEDICARE PAYMENT
• Issues with measuring physician quality
o Issue of attribution- do you penalize or reward all doctors who treat the
patient or just the one who is "responsible"
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