Schumacher and ECI merger would create physician-staffing giant, -AND- Medicare Lays Out Plans For Changing Doctors' Pay

CAL/AAEM News Service at
Tue May 10 10:56:48 PDT 2016

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Chapter of the American Academy of Emergency Medicine


April 22, 2016


Schumacher and ECI merger would create physician-staffing giant


Modern Healthcare


By Dave Barkholz


Schumacher Clinical Partners, a physician staffing company with 5,200
doctors contracted to hospitals, is acquiring ECI Healthcare Partners. Terms
were not disclosed.


Schumacher of Lafayette, La., has a major presence in the southeastern U.S.
and in the Gulf states, while ECI's major markets are complementary in
California, along the west coast, in the Northeast and the Midwest,
Schumacher CEO Rich D'Amaro said in a release.


Schumacher has about 300 contracts to staff hospital emergency rooms and for
hospitalists, serving about 6 million patients annually. Traverse City,
Mich.-based ECI has about 2,000 employed physicians and 150 contracts
serving 2 million patients. The combined company will operate in 32 states.


"Being physician-led and patient-focused for the last 44 years, the creation
of this new company gives us the opportunity to advance the service and
value we bring clients and patients in today's competitive healthcare
environment," Dr. Derik King, president of ECI, said in the release.


The companies said they expected to complete the deal in the second quarter.


Schumacher was founded in 1984 by Dr. William "Kip" Schumacher, who still
serves as the company's executive chairman. ECI was founded in 1972.


Both are dwarfed by TeamHealth in Knoxville, Tenn., the nation's largest
contract physician staffing company with about 15,000 employed physicians.


TeamHealth physicians see 10% of all ER patients across the country and the
company annually recruits 20% of all ER residents nationwide.


April 29, 2016


FAQ: Medicare Lays Out Plans For Changing Doctors' Pay


Kaiser Health News


By Mary Agnes Carey

Federal officials have unveiled their roadmap to a revamped Medicare
physician payment system designed to reward doctors and other clinicians for
the quality of care delivered, rather than the quantity.


The proposed regulation would replace a patchwork of programs that now
govern physician payments in Medicare. It would allow doctors to choose from
a new menu of measures and activities that officials said would be tailored
to the type of care clinicians provide in Medicare's traditional
fee-for-service program.


"By proposing a flexible, rather than a one-size-fits-all program, we are
attempting to reflect how doctors and other clinicians deliver care and give
them the opportunity to participate in a way that is best for them, their
practice and their patients," said Patrick Conway, acting principal deputy
administrator and chief medical officer at the Centers for Medicare &
Medicaid Services (CMS), the federal agency that is implementing the new
physician payment program.


Currently doctors are paid for things like tests, treatments and other
procedures, but not necessarily for spending time with patients to learn
more about their health or develop a treatment plan. Officials say the new
payment program will change that.


With wide bipartisan support, Congress last year voted to scrap the existing
Medicare physician payment formula and transition to a new system focused on
quality, value and accountability. Here are some questions and answers about
the newest phase of this effort.


Q: What is the government offering?

A: The proposed regulation would create two new payment systems. One, called
the "merit-based incentive payment system," or MIPS for short, would
evaluate the value and quality of care on four performance categories: cost,
quality, how doctors use electronic health record technology in their daily
practice and share that information with other providers, and activities
that improve care, such as care coordination or how much beneficiaries are
engaged in their care. That composite score is used to determine a positive,
negative or no adjustment to a provider's Medicare Part B payment for a
medical service.


The second system for doctors sets payments through "advanced alternative
payment models" or advanced APMs. Under these models, clinicians accept more
risk - and could also make more money - for providing coordinated,
high-quality care, according to CMS. Examples include efforts to create a
centralized "medical home" in which a team of health professionals provide
coordinated care to improve patients' health, and newer models ofaccountable
care organizations in which doctors, hospitals and other health care
providers form networks that work together to help improve the quality and
reduce the spending for patient care.


CMS officials expect that most Medicare clinicians will initially
participate in the MIPS program but over time will move more toward the
alternative payment models.


Q: Who will get paid this way?

A: Most doctors that treat patients in the traditional Medicare program, as
well as other clinicians, such as physicians assistants, nurse
practitioners, clinical nurse specialists, and certified registered nurse
anesthetists, that also provide care to Medicare beneficiaries, will be paid
under either the MIPS or advanced APMs system. Clinicians can be exempted
from MIPS if they are new to Medicare, have less than $10,000 in Medicare
charges or see 100 or fewer Medicare patients or are "significantly
participating" in an advanced APM.


Q: Why is this happening now?

A: As part of legislation Congress passed last year to overhaul the Medicare
physician payment system, CMS had to publish a plan by May 1 that detailed
how it would measure physician quality under the new system. Doctors and
other interest groups can now comment on the proposal until June 26, and CMS
is expected to issue a final rule this fall.


Q: What happens next?

A: Under the law setting up the changes in payment, physicians will receive
a fee increase of 0.5 percent per year between 2016 and 2019 as the new
system is developed and put into place. In 2017, Medicare will begin
measuring performance for doctors and other clinicians for the MIPS program,
with payments based on those measures beginning in 2019. Under that system,
payments generally won't increase or drop by more than 4 percent, rising
gradually to 9 percent from 2022 and beyond. Doctors can earn additional
bonuses for exceptional performance.


Practitioners who pursue APMs would qualify for a 5 percent Medicare Part B
incentive payment for the years 2019 through 2024.


Q: Does this mean that Medicare beneficiaries will pay more to see their


A: The law does not change payments by beneficiaries. Medicare Part B
premiums, which cover visits to a physician and other outpatient services,
are set by law and adjusted yearly. Once the Part B deductible is met,
beneficiaries usually cover 20 percent of the amount Medicare pays, or
purchase a supplemental policy that can pick up much of that cost. If
Medicare's Part B costs increase because of the new payment formula,
beneficiaries' premiums and co-payments could potentially rise as well.


Q. How did the doctor payment formula become an issue?

A: The prior physician payment system, which was called the sustainable
growth rate or SGR, was created in a 1997 deficit reduction law, a broader
legislative effort to control federal spending. For the first few years,
Medicare expenditures did not exceed the target in that law and doctors
received modest pay increases. But in 2002, doctors were furious when their
payments were reduced by 4.8 percent. Every year since, Congress has staved
off the scheduled cuts. But each deferral just increased the size of the fix
needed the next time. Last year, lawmakers finally agreed to cut a deal for
repeal and move on.


Q: What's been the reaction to the new physician payment proposal?

A: Doctor and physician groups appear to be on board so far and a few
lawmakers in both parties also have expressed support. All pledge to
continue to monitor the process.


In a statement, the president of the American Medical Association, Dr.
Steven J. Stack, said the group's "initial review suggests that CMS has been
listening to physicians' concerns" in particular by modifying federal rules
concerning physicians and electronic health records and reducing burdens on
quality reporting. The new system, Stack said, "needs to be relevant to the
real-world practice of medicine and establish meaningful links between
payments and the quality of patient care, while reducing red tape."


Robert Berenson, a fellow at the Urban Institute, said a key question for
the law is "have they set it up so small practices can actually stay in
business and report so they don't have to throw in the towel and get hired
by somebody because the reporting burden is too great?" Berenson, who has
been critical of the new Medicare physician payment law, is a member of a
technical advisory committee created in the law to evaluate its


Paul B. Ginsburg, who serves as director of the Center for Health Policy at
the Brookings Institution and is also director of public policy at the
Schaeffer Center at the University of Southern California, said the proposed
rule gives physicians a lot of flexibility in choosing how they are rated
under the MIPS program but is more restrictive on what qualifies as an APM.


Payment increases under either system may not be generous enough to keep up
with other costs, such as increases in practice expenses. "This is better
than a 20 percent cut (under the old system) but in a sense it means that
the very severe constraint on physician payment is going to continue for
some time," he said.



Jeff Wells
Deputy Editor, CAL/AAEM News Service


Brian Potts MD, MBA
Managing Editor, CAL/AAEM News Service

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