MODULE 5 - CASE

Module 5 - Case



Module 5- Case

Brief Description of the Current Medicare System

The concept of Medicare has evolved considerably since it was formed in the year 196. The physicians used to get reimbursed for their services covered by the program and used to charge patients for those costs which were not covered. The reimbursement methods of the Hospital followed by them had similar functions until a change took place in the year 1983 in the payment system which had contents of the past. In 1992, the program of the payment fee replaced the old payment system based on charge fee. The concept of Sustainable Growth Rate (SGR) in the year 1998 was established in order to minimize the rate of spending. The yearly goals regarding the rate of spending were also created and the physician payments also decreased in order to avoid the exceeding of spending limits.

In the present times, the major portion of the current costs of Medicare is quite dissimilar from the past statistics. There is a major chunk of the expenditure which is attributed towards the outpatient services covered by Part B of Medicare. This particular expenditure has exceeded the current formula specified by the SGR at numerous times. The future changes in the form of reimbursement cuts create a major problem for all those physicians that receive reimbursements for services directed to the Medicare patients. This is a serious issue and it requires a solution which can otherwise lead the doctors to leave their job in the Medicare program because of the constant reimbursement cuts. This factor would seriously affect the services of the patients having their treatment under the Medicare program. Therefore, a need for legislation is necessary to resolve the problems associated with the Current Medicare Payment Mechanism (Chris, 2012).

Reimbursement of the ACOs

The topic of Accountable Care Organizations has gained a lot of importance in the recent times. In the current scheme, the ACOs will provide care of the Medicare patients. It was stated that the ACO will be formed with the group of the providers, hospitals or the physician groups as there would not be any middle men which can manage the work. The ACO model was developed in order to decrease the costs but they can be held accountable for not providing quality. CMS will not regulate the functions of the ACOs. The main idea is that the ACOs can develop different models for organizing the work and meet the budget targets along with quality goals. Though, the management of the ACOs will matter a lot because it can prove costly if they would not perform well.

In the traditional fee system of the Medicare, doctors and hospitals are paid much higher money when they conduct more tests for the patients along with some other procedures. The experts stated it as the increase in the costs. ACS will not have the same payment system as compare to the traditional fee system of the Medicare but it would ...