One drawback to the proposal in Congress is that it moves too gradually. Starting in 2016, doctors who shift to a new payment arrangement would get a 5 percent bonus. There’s no penalty for not taking part: The law would simply freeze the current payment rates. Nor are there any targets for doctor participation, and those who want to keep using fee-for-service can do so indefinitely.
The slow pace of change isn’t the only area where the proposal could be improved. It offers the bonus even to physicians whose costs remain unchanged, which is hard to justify if part of the purpose of the new program is to reduce medical costs. The new system would cost approximately $150 billion over 10 years, initial estimates suggest — but there’s no indication how it should be paid for. Most important, there’s no guarantee that new payment method would make Medicare more cost-efficient.
Still, all these caveats amount to issues to be addressed, not reasons to stick with the status quo. The financial stakes are too great not to embrace reform: Medicare spent $131 billion on physician and clinical services last year alone, a figure that’s projected to almost double by 2022. Changing the way doctors are paid is more necessary than ever.