Health Management Associates (HMA) recently released a white paper focusing on the Medicare Physician Fee Schedule (PFS) and the urgent need for reform in the $90-plus billion payment system. The paper delves into the history of the PFS, stakeholder perspectives on reform, major structural issues, and recommendations for improvement.
As bipartisan calls for reform of Medicare reimbursement for healthcare services grow louder, stakeholders are pointing out the misalignment of the current system with modern practice patterns and market dynamics. The PFS, which has faced minor updates but no major overhaul, is criticized for its known pricing distortions and lack of alignment with value-based care principles.
HMA’s white paper, supported by Arnold Ventures, aims to provide a comprehensive analysis of the PFS and the key moments that have shaped its current state. The document outlines structural topics within the PFS that have prompted calls for reform, offers historical context on the payment system, and presents stakeholder perspectives on the need for change.
To address these pressing issues, the paper includes a series of recommendations for the Centers for Medicare and Medicaid Services to improve payment accuracy, promote the adoption of alternative payment models, and strengthen the system for the future. These actionable steps are designed to facilitate idea generation and process improvement within the PFS.
For more information on the PFS and the push for reforms, the white paper is available for download. Additionally, an electronic timeline highlighting key policy developments related to the PFS since its implementation in 1992 can be accessed online.
HMA is a nationally recognized research and consulting firm specializing in healthcare and human services policy, programs, financing, and evaluation. With a team of over 700 consultants across the country, HMA provides valuable insights and expertise to government agencies, healthcare providers, health systems, and other stakeholders in the healthcare industry.
As a philanthropy dedicated to addressing critical issues in the United States, Arnold Ventures supported HMA’s research on the Medicare Physician Fee Schedule. Their collaboration underscores the importance of evidence-based policy, research, and advocacy in tackling pressing problems within the healthcare system.
For more information on HMA and their work in healthcare policy and consulting, visit their website at healthmanagement.com. Stay informed about industry developments and insights by following HMA on LinkedIn and X.
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