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June 2011
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Changes Needed to Allow Reimbursement for ID Physicians’ Systems-Level Activities, IDSA Says

IDSA continues to advocate for changes to assist ID physicians in receiving adequate reimbursement for providing infection prevention, antimicrobial stewardship, and other services that may not involve direct patient care but that avoid complications and their associated health care costs. In June, IDSA called on the Centers for Medicare and Medicaid Services (CMS) and the Office of the Inspector General to establish waivers, safe harbors, and/or exceptions to federal anti-trust laws as a means to incentivize a range of innovations in health care delivery, including these ID-related services. Federal law currently imposes strict limits on compensation arrangements between physicians and hospitals.

The Society’s comments (PDF) came in response to proposed regulations that would waive anti-trust laws in certain situations involving Accountable Care Organizations (ACOs), a proposed new model of care that would allow integrated groups of providers to share in savings generated by providing more efficient, high-quality care. IDSA is also working with a law firm to develop legal arguments necessary to help ID physicians in negotiating incentive-based or “gainsharing” arrangements with local facilities for physicians’ activities that do not involve patient care, including infection prevention and antimicrobial stewardship. 

Evidence suggests that a large proportion of ID physicians accept reimbursement levels that are well below their market value. In a 2007 survey by the Society for Healthcare Epidemiology of America, 37 percent of respondents who provide infection control services and 74 percent of those who provide antimicrobial stewardship services said they were not getting paid for this work.

IDSA also urged CMS to make changes in proposed regulations for the Medicare Shared Savings Program, which is intended to encourage the formation of ACOs that are able to reduce costs while also improving the quality of patient care. IDSA called on CMS to minimize the administrative burden and maximize flexibility to encourage innovative ACOs to form. The regulations, if finalized in their current form, would likely discourage many, if not most, provider groups from forming ACOs and would limit their impact, IDSA said. Several other medical groups have raised similar concerns. IDSA’s comments are available online (PDF).
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