New Medicare law

[PennPA4]

Hey guys. I was trying to search the text for new law passed last month for Medicare payment but u couldn't find it. I know it eliminated SGR but did it eliminate also 85 percent rule? ( PAs are reimbursed at 85% of MD visit)

Thanks

[dhageremtp]

I have not read this bill entirely, from what I have gotten through nothing is mentioned about changing the 85% however there is verbiage to including a 0.5% payment rate increase for the next 5 years.

[jmj11]

And then by 2019 go to one "quality" merit systems for payment increases or decreases. Here is where PAs will get into trouble. Our merit will have the choice of comparing us to "peers in our specialty" or (APM) or general merit (MIPS).  This is another area that could spell trouble for PAs. To CMS, and many other insurance companies, we are either invisible or we are compared to others in our specialty and the only specialty that a PA can have is “Physician Assistant.”  This is very wrong and needs to be corrected.

 

As a sign of things to come, we had a denial of payment for seeing a migraine patient who has daily, severe migraines for 40 years, who has been to 4 neurologists, then the U. of Washington Headache Clinic, Mayo Clinic Headache Clinic and who has failed 30 years of treatments. I spent 90 minutes with them because they had traveled 300 miles. I was compared to a PA in urgent care who saw a migraine patient and spent 10 minutes with her. But he was considered my “specialty peer” because he is also a PA.  This is the danger with us being set as Physician Assistant specialty.

[TWR]

^^^^^^  needs to be brought to the attention of AAPA.  I am coming around to thinking that our #1 priority should be abolishment of the 85% reimbursement THEN name change.  Call me Tallulah but pay me at 100%.  That will get the attention of the Dr.s looking for PAs  IMHO

PS I am a cardcarrying member of PAFT from the beginning.

[Guest Paula]

The law also put PAs at same standing as NP, physician for value based payments and to be considered equally.

[LKPAC]

https://www.aapa.org/twocolumn.aspx?id=2147485242

[TWR]

thanks LKPA, definitely a step in the right direction albeit a tippy toe one!

[KMD16]

Excellent. Good to know. We still have a long way to go in this battle when compared with NPs. A step forward indeed!

[Guest Paula]

This morning at my provider meeting the regional VP told us about the Wisconsin Health Initiative that tracks physician data based on billing.  About 20 insurance companies in WI

participate.  The data collects data for FP, General Internal Med and Pediatrics and rates the physician groups on the health metrics achieved.  Then the data is made user friendly for patients, they can log on to a patient site, plug in their zip code and see if the physician group has high ratings.  I asked if PAs and NPs are included.  He did not know but said he could just plug in a name and find out (which he did not do then).

 

I entered my zip code, the data pops up that FP/IM at my clinic has very low scores and the Peds department is middle of the road.  What does this mean?  No PAs or NPs data is recorded.  I tried to register but only physicians or clinic could register.  The physicians listed with my group are not up to date, several have retired, so obviously the data is at least 2 years old. The small print says the data is NOT reflective of individual physicians but of the group as a whole.  Now as a consumer (patient) I would assume it was physician individual data as when you click the box to look at the group all the physician names pop up.  In my FP section there is ONLY one physician, my collaborating physician.   So what will a patient think?  I doubt the fine print is read or even seen or understood.  Patients will think we give crappy care.  I could not find exactly what data is collected as the link to that info did not work. 

 

I believe  jmj has an excellent point and the next issue is to address the invisibility of PAs and AAPA intimate in that announcement they are aware of how we are no recognized.  

 

I am now concerned about the category of PA as a specialty as jmj has alerted us and agree it is NOT GOOD for us.  I will bring this up at the next PAFT meeting. 

 

I also emailed the Wisconsin Initiative and asked if PAs and NPs can register and get our data collected.  It will be interesting to see if they answer me.