§1395cc–1 Demonstration of Application of Physician Volume Increases to Group Practices

Summary

The Secretary must run test projects that try paying doctor groups for working together, improving office systems, and getting better patient results. The tests will compare how efficient care is in group-practice settings versus other ways care is given. The Secretary can run the program under rules in a related section. Groups chosen for the tests must meet size, patient, service, and quality rules the Secretary sets, agree to be paid on a fee-for-service basis (with payments possibly sent to one entity), and give the Secretary needed data. The Secretary will also pick which patients are counted in each test and must tell those patients about the incentives and any changes to coverage or payment rules. For each group the Secretary will set a base amount equal to past average payments under parts A and B and make a yearly per-person spending target that is adjusted for risk and growth. If the group spends less than the target, the Secretary will pay the group a share of the Medicare savings as a bonus. The Secretary can also pay extra bonuses for better care processes and patient outcomes once rules for that are in place. Bonuses must be limited so total Medicare spending for the covered patients does not exceed what it would have been without the tests. Definitions (one line each): Physician — someone who provides services paid as physician services under this law. Health care group — a group of physicians organized to provide those services; it can include hospitals or others who join and share bonuses.