The Trump Administration has proposed major changes in the way Medicare pays doctors, as well in the ways hospitals disclose prices. Among the immediate adjustments: The government would pay more for some procedures such as kidney dialysis and less for others such as hip and knee replacements.

It would also make major revisions to an ambitious new payment model that was intended to encourage doctors to focus on the quality of care rather than the volume of procedures. Critics say that key elements of those new rules would discourage physicians from participating in the new program and slow the movement to quality-based care.

Cutting costs for new knees

The proposed 1,473 page rule from the Centers for Medicare and Medicaid Services (you can read it here), addresses two broad issues: 2019 payment rates for Medicare providers and more fundamental changes in the way the Trump Administration wants to compensate doctors, hospitals, and nursing homes.

To start with the immediate changes in payment rates, CMS believes that it is paying too much for a number of common procedures for older adults and wants to reduce its fees. They include: total hip and knee replacements, colonoscopies where lesions are removed, certain CAT scans of the head, and electrocardiograms.

CMS would also make two changes that reduce two fees related to cancer treatment. It would cut in half the current 6 percent fee that doctors get for administering drugs in their offices, and it would reduce payments oncologists get for evaluating and managing complex cancer cases (known as E&M).