Medicare eyes changes to pay for specialty care

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The Biden administration is getting serious about transforming Medicare payments for specialty care.

Some doctors will be required to participate in programs that pay fixed amounts for care connected to certain surgeries and procedures.The Centers for Medicare and Medicaid Services says it has struggled to control health spending and boost the quality of care through steps like coordinating primary and specialty care.

Giving primary care providers insight into specialists' performance data could help boost referrals to high-performing specialists, CMS said. The strategy also involves finding financial incentives for better coordination between primary care providers and specialists in caring for patients.payment model built around "bundled" payments for episodes of care, to incentivize providers to manage their spending.bundled payment plans for bypass surgery, hip procedures and joint replacements in 2017 after providers complained about the mandatory nature of the programs.

 

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