FEATURE
WILL 2019 BE A Year of Change in Washington?
Tom James, MD
W
22
ashington moves in mys-
terious ways. There are so
many agencies that coor-
dination of thought and
action frequently leads to
regulation and programs seemingly at odds.
However, there are some basic elements to
the directions for 2019, where there is con-
sensus within the Beltway. All agree that American citizens do not
receive value from the health care system. The costs are too high
compared to other industrialized nations; and the outcomes in terms
of mortality, morbidity and standard quality of care metrics place
the United States lower in standing. For the individual physician
or for the group practice, this can be disheartening. It may seem
that Washington wants all segments of the medical community to
provide better outcomes for patients with fewer financial resources. enormous burden that data collection places on medical practices.
These various objectives can be captured in the word “value.” That
word itself implies the fraction of objective measureable outcomes
divided by the cost of care. The emphasis on bringing down costs has
been an objective for the last decade, but the strategies are evolving.
Likewise, the quality side is going through a metamorphosis as CMS
and the measurement organizations have started to recognize the The Physician Fee Schedule (PFS) has been a target of the current
administration. The view is that the Evaluation and Management
(E/M) codes no longer serve as a good distinction between levels of
service in an era of electronic medical record documentation. Rather
than find better ways of distinguishing long, difficult office evalua-
tions from short office visits, CMS originally proposed collapsing the
LOUISVILLE MEDICINE
As the Center for Medicaid and Medicare Services (CMS) has
indicated in its own Quality Strategy document, its goal is to “build
a health care delivery system that’s better, smarter and healthier - a
system that delivers improved care, spends health care dollars more
wisely, and one that makes our communities healthier.” Because of
its size, CMS is moving from being just a payment vehicle to being
the economic and regulatory force which drives change in the way
medical care is provided in this country. The tools it uses are ones
creating incremental change, but CMS can do more than commercial
insurance companies, that will follow in the CMS wake. At least the
talk within CMS is no longer on a single-payer system i.e. Medicare
for all. Still CMS is using the following drivers to improve access
and reduce the economic burden of healthcare services.
COST: