Mid-Atlantic Health Law TOPICS

On July 15, 2008 Congress passed the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA), overriding President Bush’s veto. While most health care providers know that MIPPA prevented a negative 10.6% adjustment to physician fees paid by Medicare, many are not aware of another aspect of MIPPA, namely the Physician Feedback Program.

The Physician Feedback Program (Program) is to begin January 1, 2009. Upon implementation, it will provide data to physicians and physician groups that identifies whether the physicians or groups are outliers when compared to the practice patterns of others.

The Program will collect Medicare claims data, and provide confidential feedback to physicians and physician groups on a per episode or per capita basis (or both). The Program may also study physician specialties, high volume and high value patient conditions and certain physicians that use a high amount of resources. The Program may also focus on certain geographic areas, and physicians who treat a minimum number of Medicare beneficiaries.

According to MIPPA, the Government Accounting Office is to report to Congress by March of 2011, as to whether the Physician Feedback Program caused physicians to change their practice and billing patterns, and whether the Program reduced overall Medicare payments to physicians.