|
|
|
|
|
Search
09/18/2025
RESPONSES/COMMENTS (VALUE-BASED CARE)
RE: Value-Based Healthcare is Coming...Please Be Ready
From: Michael King, DPM
DPMs, Are you prepared for the changes to come with Medicare over the next few years? CMS wants to move to a value-based care (VBC) compensation system by 2030: CMS has set a goal of having 100% of Traditional Medicare beneficiaries and the vast majority of Medicaid beneficiaries in accountable care relationships by 2030. CMS VBC 2030 fee-for-service will not be gone right away, but DPMs must be prepared for the move to VBC.
Patient management within a value-based system can be both cost-saving and rewarding for patients and providers. We must be part of these changes early to assure we are part of the solution and not the problem. ACO REACH allows the DPM to be part of the gate-keeping system for patients, affording them access to all levels of care necessary to keep them healthy. We have the opportunity to change the paradigm of healthcare. Let's be ready.
Michael King, DPM, Nashville, TN
Other messages in this thread:
10/01/2025
RESPONSES/COMMENTS (VALUE-BASED CARE)
From: Steve Tager, DPM
While I agree wholeheartedly with Dr. Kornfeld's and Dr. Tager's advice, one VERY important point is mostly missed when recommending a change to a direct pay or cash basis model of practice: just like in the real estate business, it is about location, location, location.
Narmo L. Ortiz, Jr., DPM, Davenport, FL.
09/30/2025
RESPONSES/COMMENTS (VALUE-BASED CARE)
From: Steve Tager, DPM
I tell this story with the sole purpose of helping those in the profession who are fed up with the current nonsense and mental gymnastics required to sustain the traditional and current model solo or group podiatry practice today. And more so, the uncertainty on the horizon.
For reference, starting solo practice in 1966 after a short stint in a terribly busy practice (60 patient/day; 40 to me and 20 to the owner), I quickly learned a bit about private practice and its management. So, without hesitation and extremely limited business experience, in the winter of 66 I opened my practice in a medical building in Cranston, RI. After 16 years experiencing ridiculously low reimbursement from RI BCBS, a move to Northern CA made sense for a variety of...
Editor's note: Dr. Tager's extended-length letter can be read here.
09/29/2025
RESPONSES/COMMENTS (VALUE-BASED CARE)
From: Elliot Udell, DPM
Although many of us have disagreed with Drs. Kornfeld and Roth with regard to not accepting insurance as payment for our services, the times we live in might cause us to rethink our disagreements. I recently had cataract surgery. The doctors agreed to accept insurance for the removal of the cataract, but in order to use their laser machine to make and close the incisions and correct astigmatism, I had to cough up two thousand dollars, cash.
The bottom line is that this prominent and well-respected eye care center was not willing to give up taking insurance totally, but they found a good way to supplement their income by charging an out-of-pocket fee for part of the procedure. Perhaps Drs. Kornfeld and Roth can suggest ways in which podiatrists could accept insurance for certain services and charge out-of-pocket for others.
Elliot Udell, DPM, Hicksville, NY
09/27/2025
RESPONSES/COMMENTS (VALUE-BASED CARE) - PART 1B
From: Robert Kornfeld, DPM
I am well aware that most of you in this profession see me as a rabble rouser and a quack. But what is happening in the world of insurance-dependency is something I predicted more than 20 years ago. All of the changes that you are working so hard to understand so you can "capitalize" on it will not put you in a better position. The reality, as I have repeatedly opined, is that you will continue to suffer in this insane system that does not give a rats a*s about your emotional or financial health.
I still cannot understand why podiatry is resisting the direct-pay model when MDs and DOs are embracing it and in their world, the mutiny is now! Why is podiatry so different? What is it about this profession that keeps you "cooperating" with these companies, be they insurance companies or PE employers, that continue to destroy your professional satisfaction and self-esteem?
I graduated from NYCPM 45 years ago. In my early years of practice, it was incredible. Reimbursements were high (bunions with osteotomies paid around $4,000-$6,000 in the '80s). Forefoot reconstructions could pay $8,000-$12,000. What are you being paid now? Your training and expertise in the OR are meaningless. You will get whatever they decide they want to give you. And it is less and less and less with time and will continue to decrease. So here is what I think. PUT ON YOUR BIG BOY AND BIG GIRL PANTS and leave the system that is killing you day by day.
Robert Kornfeld, DPM, NY, NY
09/27/2025
RESPONSES/COMMENTS (VALUE-BASED CARE) - PART 1A
From: Ron Freireich, DPM
Dr. King, thank you for your response and your comments regarding the growth of Medicare Advantage plans and patient preferences. The growth of these plans stems from their lower premiums compared to Medicare part B, however many of my patients are not aware of the high co-pays that they are responsible for at each visit and many are not even aware the they no longer have Medicare part B, and in reality now have a private insurance product. And this brings me to my second point. Insurance brokers are paid a commission for selling Medicare part C and NOT Medicare part B plans. I feel this fact alone is what drives many patients into these plans. The following is what AI says about patient satisfaction with Medicare part C.
Patient satisfaction with Medicare Part C (Medicare Advantage) varies significantly, with many enjoying the added benefits like dental, vision, and hearing care, but others experiencing frustration with limited provider choices, network restrictions, and the need for pre-approvals and referrals, which can cause care delays. While enrollment is high and increasing, people in poor health report lower satisfaction and more difficulty accessing care, sometimes leading them to switch back to traditional Medicare.
Regarding provider satisfaction of MA plans, most if not all providers do not favor these plans due to lower reimbursements (which is what CMS desires) and difficulties with prior approvals and pre-determination of benefits, not to mention difficulties collecting co-pays and the extra time it takes for staff to explain to many patients the reason that they no longer have Medicare part B. Medicare part B is very transparent about everything, part C plans are just the opposite.
Ron Freireich, DPM, Cleveland, OH
09/25/2025
RESPONSES/COMMENTS (VALUE-BASED CARE) - PART 1A
From: Lawrence Rubin, DPM
Adding some information to Dr. Freireich's post on value-based care and MSOs in general; a podiatry value-based "messenger model" Independent Practice Association (IPA) could help podiatrists avoid pitfalls associated with Accountable Care Organizations (ACOs) and gain leverage in contract negotiations.
Unlike the ACO model, an IPA protects provider autonomy, aligns incentives towards profitability, and focuses on demonstrating collective value and cost-effectiveness through aggregated performance data. This allows the IPA to offer payers exclusively negotiated access to a high-performing network in exchange for maximal reimbursement rates.
Lawrence Rubin, DPM, Las Vegas, NV
09/25/2025
RESPONSES/COMMENTS (VALUE-BASED CARE) - PART 1B
From: Michael King, DPM
While I certainly understand the skepticism regarding the overwhelming alphabet soup of healthcare innovations, I wouldn’t characterize most of those acronyms as failures. Medicare Advantage (MA) has grown around 7% a year and now makes up the majority of our senior care. HMOs constitute the majority of MA, and thus HMOs also continue to grow. Patients selecting MA are what drives the growth of both. We can disagree with the new programs, dislike or even hate the changing landscape, but we cannot ignore the growth of these programs, the public commitments of every major health plan and CMS towards VBC, nor what this growth conveys about patient preferences.
Your last point, “They’re setting us up to fail again” is the very fear we all have. And this is the reason it is imperative to have a seat at the table of change rather than waiting and hoping CMS, UHC, and Aetna abandon their goals. We have meetings with CMS and every major national health plan routinely so that we can understand their new programs, and be at the forefront of change in a way that helps podiatry flourish and meets the payer’s goals. As your friend found out, not everyone can be a winner in the new VBC world (otherwise healthcare costs just keep rising!), so it is important to start paying attention to who is successful, learning the new rules of the road, and aligning yourself with the right partner.
The healthcare world is changing, and if we don’t participate in that change because we don’t like it, we will be left behind playing a game that someone else created without our input.
Michael King, DPM, Nashville, TN
09/24/2025
RESPONSES/COMMENTS (VALUE-BASED CARE)
From: Ron Freireich, DPM
I'm no expert on ACOs, however after being in practice for over 30 years I can say that alphabet solutions to the financial side of healthcare have failed every step of the way. I'm talking about HMOs, PPOs, PHOs, MA (Medicare Advantage), MIPS/MACRA, and now ACOs. One key feature of an ACO is Quality Performance Measures, AKA pay-for-performance, where providers must meet specific quality standards to earn back withheld payments. Sound familiar? To me, it sounds very similar to MIPS/MACRA whereby providers meet specific measures in order to receive a bonus in their reimbursements. Well, we know how that has turned out. Originally, we were told that we could receive up to a 14% bonus but at the end of the day, it rarely exceeds 2% and for providers that do not participate, they receive a penalty.
A colleague recently sent me an incentive update from a large ACO that read in part, "Our revenue is recognized as it is received during a calendar year, while reflecting the performance from the years prior. Unfortunately, the revenues received in 2024 were not sufficient to cover our program expenses and pay an incentive." All that work for nothing. ACOs which are part of a value-based system are supposed to reward "value over volume". Does anyone really think that providers are going to be paid more with less volume? They're setting us up to fail again. This will be a system designed to pay us even less than we are receiving now. As the saying goes, "the definition of insanity is doing the same thing over and over again and expecting different results."
Ron Freireich, DPM Cleveland, OH
|
| |
|
|
|
