Would your physicians jump at the chance to bid to treat Medicare patients? It's an idea former CMS senior advisor Peter Bach MD, a pulmonary specialist at Memorial Sloan-Kettering Cancer Center in New York, opined about in today's The New York Times.
Dr. Bach offers competitive bidding as a solution in his article "Let Doctors Bid for Medicare Business" to save the Medicare program money and eliminate discrepancies and overutilization of services from region-to-region. He notes New York City has 186 specialists per 100,000 residents, double the amount of New York state's capital, Albany (93 specialists per 100,000 people). It comes as no surprise that Medicare spends $12,114 a year per patient in NYC and $5,950 per patient in Albany, he notes.
His plan is this: make Medicare providers in markets deemed to have an oversaturation of physicians bid for the privilege to treat patients. The bidding in those regions would start below the current conversion factor of $36.0666. So, if the bidding starts at $30 and not enough physicians signed on to the program, the rates would rise until enough physicians raise their bid paddles.
In areas where there aren't enough physicians, the bidding could start above $36 - encouraging physicians to go to underserved populations.
There are several issues one could raise with Dr. Bach's plan - but, it's creative. You should read the full article to understand the details on how it works. He says physicians that don't bid can still treat their patients as a non-participating provider (automatically earning 5% less than the standard rate), but I believe his plan would perpetuate the current model of rewarding for quantity and penalize those providing higher quality of care. Wouldn't physicians earning less than before want to treat more patients?