American College of Physicians: Internal Medicine — Doctors for Adults ®

Advertisement

At press time...

HCFA to risk-adjust pay for Medicare HMOs

From the February 1999 ACP-ASIM Observer, copyright 1999 by the American College of Physicians-American Society of Internal Medicine.

Beginning next year, HCFA will pay Medicare HMOs based on the health of individual patients, a move that could affect physician reimbursement.

With risk-adjusted payments, health plans could receive more than $26,000 per year for members with diseases like AIDS. Payments for healthy members of Medicare HMOs could drop by as much as 20%.

As part of the trickle-down effect, physicians treating sicker patients could see increased reimbursements from health plans for Medicare members, according to the College. Physicians with healthier patients, on the other hand, might see their pay fall.

Some Medicare HMOs have already complained that lower rates for healthy patients could drive more health plans away from Medicare. Nearly 100 health plans have recently left Medicare, stranding patients and physicians. (See "Tough times as Medicare HMOs fold," this page.)

HCFA intends to phase in its new pay rates over five years. While the agency will initially risk-adjust payments using only inpatient data, it plans to include outpatient costs incurred by physicians in its risk-adjustment formula by 2004.

This is a printer-friendly version of this page

Print this page  |  Close the preview

Share

 
 

Internist Archives Quick Links

MKSAP 16 Holiday Special: Save 10%

MKSAP 16 Holiday Special:  Save 10%

Use MKSAP 16 to earn MOC points, prepare for ABIM exams and assess your clinical knowledge. For a limited time save 10% when you use priority code MKPROMO! Order now.

Maintenance of Certification:

What if I Still Don't Know Where to Start?

Maintenance of Certification: What if I Still Don't Know Where to Start?

Because the rules are complex and may apply differently depending on when you last certified, ACP has developed a MOC Navigator. This FREE tool can help you understand the impact of MOC, review requirements, guide you in selecting ways to meet the requirements, show you how to enroll, and more. Start navigating now.