Could Medicare’s New Doctor Payment System Endanger Small and Rural Practices?

Lee Gross is worried. He has practiced family medicine in North Port, Fla., near Sarasota, for 14 years. But he and two partners are the last small, independent medical group in the town of 62,000. Everyone else has moved away, joined larger organizations or become salaried employees of hospitals or health companies.

“We’re struggling to survive,” Gross said. “Our kind of practice is dying in this country, and medicine itself is changing so rapidly that doctors everywhere seem to be burning out.”

The latest challenge — a target of growing physician anger and frustration nationwide — is a 2015 federal law that changes the way Medicare pays doctors. Many fear it will sharply increase the financial pressures that physicians in rural, solo and small practices face.

The Medicare Access and CHIP Reauthorization Act was Congress’s boldest step since the 2010 Affordable Care Act to push the health-care system to reward quality over quantity. The law, which passed with bipartisan support, seeks to use monetary incentives and performance measures to promote better care. It replaced a widely derided reimbursement formula that Congress regularly ignored because it would have cut payments to doctors.

“This is a big change, we know,” said Tim Gronniger, deputy chief of staff at the Centers for Medicare and Medicaid Services. But “the current way we pay doctors incentivizes them in bad ways — to waste resources, for example.”

The new law has two payment tracks. On one, doctors whose performance and quality of care exceeds benchmarks will get bonuses of up to 4 percent of their total Medicare reimbursements. Those will start in 2019, based on evaluations of care delivered in 2017, and will rise to a maximum of 9 percent by 2022.