The Nuts and Bolts of Medicare Physician Payment — And Why It Needs Reform

All families and people across our nation should have access to the health care they need at a price they can afford. But our health care system is currently designed to rake in the highest possible profits for big health care corporations rather than deliver the highest-quality care for the lowest possible cost. The way the U.S. pays for health care drives large health care corporations to buy up community doctors’ offices to form medical monopolies, set inflated prices, and generate high volumes of the highest-priced services with no accountability for health care affordability or health outcomes. The business model of these large health care corporations fundamentally relies on and takes advantage of fee-for-service payments, which serve as the predominant reimbursement model for health care services delivered by our country’s physicians and other health care professionals.

How health care providers and physicians are paid directly impacts how our health care system delivers care, including the quality of care that patients receive and the extent to which health care services are integrated and coordinated across multiple providers and care settings to effectively meet patients’ needs. And far too often, decisions about physician payment incentives are dominated by the health care industry and specialty interests focused on preserving their status quo business model at the expense of advancing pro-consumer payment reforms. As the voice for health care consumers, we know that a new approach to health care payment is needed, one that is reoriented to meet the health and affordability needs of consumers and patients.

Consumer advocates and allied stakeholders have an important role to play in providing a meaningful counterweight to health care industry interests and influence on health payment policy. U.S. health care payment and delivery systems should be meaningfully designed to provide the affordable, high-quality health care and health that all of our nation’s families deserve.