Disability Insurance Blog

Change to Medicare Presents Potential Threat to Disabled Patients


Tuesday, December 20th, 2016

In an aptly-titled article, “The next healthcare crisis: Changes in way Medicare pays doctors,” the New York Daily News reports on a piece of federal legislation that has quietly passed with little fanfare that we feel poses a real threat to how disabled patients are treated.

The Medicare Access and CHIP Re-authorization Act (MACRA) is a fundamental transformation in how Medicare pays doctors and hospitals. From our perspective, it ties payment to outcomes and doctors are going to look to paint the brightest picture of health, in order to secure payment.

The final rules were released in mid-October, when most of the country was focused on the presidential election. This is one of the most significant and complex changes in Medicare since the program was created.

Medicare traditionally pays doctors a fee for services, which include procedures, office consults and the like. The provider sends a bill to Medicare and is paid a set fee. With the implementation of MACRA, the doctor or hospital’s payment is based not on what they did, but what the outcome was. The law is poorly crafted, and the results may well be devastating to patients who have chronic illnesses or injuries.

We know from long experience in representing disability insurance claimants that not every illness can be cured and not every injury can be fixed. But tying payments to the doctors to the outcomes “achieved” could be challenging to disabled claimants who are not getting better. These doctors may be less willing to document significant impairments due to the potential of such statements undercutting their ability to get paid for their services.

Doctors who do not get paid when patients do not have optimal results will leave the Medicare system. Fewer doctors treating Medicare patients, at the same time that large numbers of Baby Boomers enter the Medicare system, has the very real potential to create a public health crisis.

Patients who are at risk will include the disabled, the fixed or low-income patients who may not have the resources to comply with all medical instructions and/or the ability to cover co-pays and high deductible.

Source: New York Daily News, “The next healthcare crisis: Changes in way Medicare pays doctors