Medicare Poised to Hit Pathologists’ Income, Again!

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IN JANUARY, THE MEDICARE PROGRAM WILL INTRODUCE a new reimbursement scheme for physicians that will alter the income for every pathologist who treats Medicare patients.

Just the fact that the federal Centers for Medicare & Medicaid Services wants to tinker in a substantial way with how it pays physicians should catch the full attention of pathologists and their practice administrators. After all, when is the last time that Medicare introduced a different way to pay physicians that increased their overall income?

The new program will become effective on January 1, 2017, as part of the Medicare Access & CHIP Reauthorization Act of 2015 (MACRA). The final rule for implementing changes in one Medicare payment stream to physicians was published on May 9, 2016. Merit-Based Incentive Payment System (MIPS) and Alternative Payment Models (APMs) are the cornerstones of MACRA and pathologists who don’t pay attention to these sections of the law have the highest probability of paying Medicare penalties for non-participation.

Pathologists have fair warning that their group practices must be prepared to participate in a way that is most advantageous. Otherwise they will see an unwelcome bite taken from their Medicare payments. And the size of that bite will increase from one year to the next.

No less than Deloitte has declared that, “MACRA is expected to drive care delivery and payment reform across the US health care system for the foreseeable future. Congress intended MACRA to be a transformative law that constructs a new, fast-speed highway to transport the healthcare system from its traditional fee-for-service payment model to new risk-bearing, coordinated care models. It has the potential to be a game-changer at all levels of our health care system.” (Italics by THE DARK REPORT.)

Do I have your attention now? MACRA is the foundation for a major shift in how Medicare pays physicians. Of course, if Medicare figures out how to pay physicians less, then private payers will quickly incorporate the same elements into their own reimbursement schemes. Recognizing the importance of helping pathologists and their practice administrators come up to speed on MACRA, MIPS, and APM, our sister publication is producing a webinar on this topic on August 25. You can get full information and register at


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