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

Summary

The Secretary must run demo projects that try out incentives for groups of physicians who treat people under Medicare Parts A and B. The goal is to get doctors, hospitals, and other providers to work together, build better admin systems, and reward doctors for better patient results. A “physician” means anyone who provides services Medicare pays as physician services. A “health care group” means a group of such physicians organized to give those services; it can also include a hospital or other providers that agree to join and share any bonus. The Secretary will set who can join the demos (size, patients, services, quality). Participating groups must accept fee-for-service payments and may have those payments sent to one entity. They must send the Secretary data the Secretary asks for. The Secretary will pick which patients are in the demo and must tell those patients about the incentives and any rule waivers. For each group the Secretary will set a base spending amount (average Parts A and B payments in a base period) and a yearly per-person target adjusted for risk and growth. Groups can earn a bonus that is a share of Medicare savings versus the target, and possibly an extra bonus for proven process or outcome improvements. Bonuses are capped so total Medicare spending (including bonuses) does not exceed what it would have been without the demos.