12 Changes That Will Affect Doctors' Income in 2015

Leigh Page


November 25, 2014

In This Article

10. Two New Websites Reporting Payments to Physicians

In 2015, physicians will have to deal with two new websites that report payments made to them by Medicare and manufacturers of drugs and medical devices. The Medicare payments website, which started in April, resulted from the removal of a 33-year injunction prohibiting CMS from reporting payments. And the CMS website reporting manufacturers' payments, known as the Open Payments site, was launched in September and is the result of a provision in the ACA.

Both websites have been plagued by technical snafus and inaccurate information. Physicians were supposed to have a chance to review their information before the sites went live, but in some cases they couldn't get on the site. Ted Mazer, MD, an otolaryngologist who is a past president of the San Diego County Medical Society, said he tried for weeks to get onto the open payments website to review his information and could not. He recalled similar snafus when the Physician Compare website opened in 2010. "For several years, I could not find my name on the site," he said. "Then I was listed as a urologist for a while."

Dr Mazur said all of these problems might seem amusing, but they have serious implications for doctors. When the Medicare payment site was launched, local media pilloried physicians who seemed to be getting very large Medicare reimbursements. For example, Dr Mazur said, the site showed payments of $100,000 or more to ophthalmologists; the money was for intraocular injections, almost all of which went to the drug maker, but this was never explained on the website. Likewise, several orthopedic surgeons were listed on the Open Payments site as being paid more than $1 million, but the money was for devices they had invented.

CMS is trying to clean up some of the problems with the Open Payments site. It plans to roll out a more simplified site by December, and in October the agency clarified that it would not be lifting an exclusion on reporting payments for continuing medical education (CME), as had been reported in July. But Dr Mazur said the damage has already been done. "The amount for reporting that physicians are subjected to is now destroying the profession," he said. "Everything we do is assumed to be wrong."

11. Medicare Starts Paying for Chronic Care Outreach

CMS' new chronic care management, which starts in 2015, is one of the few encouraging developments next year. The new program will pay physicians for managing Medicare patients with two or more chronic conditions, even when contacts are made by phone or email rather than face to face.

"This is a step in the right direction in a world that is still mainly fee-for-service," Dr Wergin said. "Studies show outcomes much better when you manage patients in this way. Family physicians have already been doing this work, but they haven't gotten paid for it."

The program could become a significant source of income for many primary care physicians. According to the final rules, released October 31, physicians will be paid $40.39 per patient per month for providing at least 20 minutes of care. Dr Wergin estimates that he personally has about 500 patients who would fit the criteria. That would mean monthly payments of more than $20,000. He cautioned that the estimate might be a little high, because patients would have to agree to enter the program, which requires an $8 copay from them each month.

To qualify for the program, physicians need to have EHR systems and be able to exchange information on the patient with other caregivers. Also, they or their staff must be available to patients around the clock. To accommodate this, Medicare has loosened its "incident to" rule, which requires doctors to directly supervise staff. Practices can also outsource the coverage or even build it into their on-call arrangements with colleagues, Dr Wergin said.

Rick L. Hindmand, an attorney at McDonald Hopkins, a Chicago law firm, warned that with so much money at stake, practices can expect to be closely monitored by regulators looking for payment fraud. "You will need to document that you are spending at least 20 minutes a month with these patients and that you are providing 24-hour access," he said.

Hindmand said setting up the EHR software and training staff will take a substantial amount of planning. Dr Wergin added that some details still need to be worked out. For example, his EHR system is not interoperable with the system at his local hospital. "We'll need to work on that," he said.


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