Louisville Medicine Volume 66, Issue 9 | Page 24

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: