What Changes Are Coming To Medicare In 2020?
The 2020 changes are significant and are the first step in moving from a system that pays doctors for volume to one that pays them for quality. Health care experts have been talking about this for years, but it's finally happening.
Here's what you need to know about the 2020 changes.
2020 Changes to the Current Model of Health Care
The current model of health care in Canada, called fee-for-service, is based on the idea that doctors are paid for how many services they provide. The more services they provide, the more money they make. It's easy to see how this leads to overservicing (excessive testing, procedures, etc.), especially when there are financial incentives to do so.
But not everyone feels the financial pressure to provide more services. If you're part of a group of specialists that has an agreement with your patient's health insurance plan, you're most likely paid a flat fee for your services, regardless of how many you provide. This is called a capitation payment.
The 2020 changes to Canada's health care system aim to move from a fee-for-service model to a capitation payment model.
What is a Capitation Payment Model?
A capitation payment model is one in which doctors are paid for each patient they see, on average, for each year of their career. That might mean a certain number of patients for every 15-minute block of time that a doctor has in a year. Or it might mean a set number of patients per week.
The capitation payment model incentivizes doctors to have good medical care and care coordination for their patients. It's also a good way to ensure that patients get the most appropriate care, because doctors are being paid for how patients perform after they leave the doctor's office. A capitation payment model is a good way of ensuring quality care.
How Will the 2020 Changes to Medicare Change the Capitation Payment Model?
Canada's current system is significantly different than the one proposed for 2020, and the 2020 changes are an important step forward. Here are the biggest changes.
1. A Capitation Payment Model Will Be Used for Specialists
In 2020, Canada's health care system will move to a capitation payment model for specialists, including family medicine, pediatrics, psychiatry, and geriatrics.
This will mean that some of your doctors will be paid for each patient they see.
2. Patients Will Have a “My Health Team”
In 2020, patients will have a “My Health Team” made up of their specialists.
The government is calling this a “primary care team,” but it's not the same as what we have now. In 2020, you won't be paying for any of your doctors with a fee-for-service model.
Your primary care team could consist of the doctors you already see (family medicine, pediatrics, geriatrics, etc.) and specialists that you need to see for certain conditions or procedures (cardiology, neurology, orthopedics, etc.).
And rather than paying an individual doctor per visit, you'll pay a certain amount each month for the services of your entire team.
3. Your Primary Care Team Will Be Paid a Flat Amount for Each Patient
This is different from how providers are paid now. Instead of being paid for how many patients they see, doctors will be paid a set amount per patient.
For the 2020 capitation payment model, the amount a doctor earns is based on the total number of patients in their primary care team.
4. Government Will Pay for Patients Who Are Not in the Trained Primary Care Team
Patients who are not part of their family physician's primary care team will be considered “out-of-network.”
What will this mean for you?
If you have a condition that your family doctor does not treat, he or she may not be on-call or be able to coordinate your care. And because the doctor is not part of your primary care team, you may have to pay for certain services, such as lab tests, imaging, or referrals.
5. Doctors Will Be Paid More if Patients Are Doing Well
One of the main goals of the 2020 model is to improve patient health and care coordination.
In order to do that, doctors will be paid more if their patients get better.
So for example, if you have asthma and you keep your asthma attacks under control, your doctor will be paid more for your care. If you take blood pressure medications and your blood pressure remains normal, your doctor will get paid more for your care.
Even if the health of your family is good, your doctor will get paid more if you visit them less often, or if you need fewer specialist visits or tests.
6. Doctors will be Paid Less if Patients Need to See Them More
Doctors will also be paid less if their patients have more health problems or need to see them more often.
This incentivizes doctors to get patients to do a better job managing their health on their own.
7. The Capitation Payment Model will Be Used for the New National Pharmacare Program
Canada's national pharmacare program will be rolled out in 2020. The model used for pharmacare will be similar to the capitation payment model used for doctors.
Your family doctor will manage your care, and you'll be able to see a specialist without having to get approval or referrals.
8. Medicare Will be Delivered by Private Insurers
Currently, Medicare is delivered by the federal government. But in 2020, Medicare will be delivered by private insurance companies.
This doesn't mean that you'll have to get private health insurance. Instead, the government will provide a basic level of insurance