It’s not just people 65
or older who will be affected
Earlier this year the
Centers for Medicare & Medicaid Services (CMS) announced plans to overhaul the way physicians are paid for
outpatient visits. If the new rules go into effect this January as planned, you
could see far reaching changes in how doctors provide medical services to you
and how much you pay for treatment annually—whether you’re currently on
Medicare or not.
Under the proposed
new rules, healthcare providers who accept Medicare will be paid the same
amount for an office visit, no matter what the patient is being treated for.
Whether you have a routine cold or lung cancer, one chronic condition or 10,
your doctor will be reimbursed at the same rate—one that’s considerably lower
than providers are paid now to treat serious health issues.
The single flat rate
is a big change from the current system, which has four levels of codes under
which physicians bill for new patient and follow up visits, based on the degree
of medical complexity involved. The more complicated the health problem, the
higher the reimbursement, since patients who are sicker tend to take more time
to care for and require longer doctor-patient discussions.
Whether you have a routine cold or lung
cancer, one chronic condition or 10, your doctor will be paid at the same rate.
Medicare says that
the goal of the proposed changes is to reduce the burden of paperwork and
documentation that doctors need to deal with, which in turn will reduce
physician “burnout” and free up more time to spend with patients.
Good goal, wrong
approach—one that could inadvertently lead to bad outcomes, many doctors say. (I am one of them.) In fact, the response over the past two months from physician groups
across the country has been near-unanimous disappointment and worry.
Here are three ways
many of my colleagues and I believe your healthcare could suffer if the
proposed changes take effect, as planned.
Less time with your
doctor
The American Medical Association and the American Academy of Family Physicians are among the many
professional organizations that have expressed concern that the new
reimbursement rules will cause healthcare employers to cut back on the amount
of time doctors on their payroll can spend with patients. After all, if a
five-minute visit pays the same as a 50-minute visit, and the overall result is
less income generated per hour, one way to compensate is to add more patients
to the schedule.
An additional
solution proposed privately by some business administrators who manage medical
practices would be to book one-problem visits. So, if you have diabetes and
hypertension, your fluctuating blood sugar levels could be addressed in the
newly shortened visit one day, and you’d have to return on another day to
discuss your high blood pressure.
And what will happen
to our most seriously ill patients? My concern, as chair of the Medical
Economics Committee of the American Academy of Neurology, is that, because
their cases are so time-consuming, there may be little time for them in private
practices, and they may be redirected to academic medical center clinics where
medical students and residents can help see patients.
More trips to the
doctor
Another part of the
CMS plan proposes to slash payment in half for office visits that occur on the
same day as procedures. So, if your primary care doctor recommends that
you see a cardiologist for an evaluation of a heart problem, you may be told
that will require one visit to see the doctor and another appointment on a
different day to undergo a heart test, when both could have been done more
expediently at the time of your initial visit.
The potential
repercussions for patients are both costly and frightening. Some doctors may
simply decide to stop seeing Medicare patients, just as many have already opted
out of accepting private insurance.
Some doctors may simply decide to stop
seeing Medicare patients, just as many have already opted out of accepting
private insurance.
But, the problem is
unlikely to end with that. When Medicare arrives at a decision, private payers often follow suit, as the National Bureau
of Economic Research has documented. If history repeats itself,
it might not be long before more insurance companies follow the CMS’s lead on
payments.
Potentially higher
out-of-pocket costs—and worse
For now at least, the
new rule could result in Medicare patients paying more for treatment since more
visits to the doctor create more co-pays.
I worry particularly
about the elderly and sickest patients, who are our most vulnerable healthcare
consumers and who I believe will be affected disproportionately by the changes.
These patients often require transportation from relatives and friends. It will
be inconvenient for their families since extra visits mean more time away from
work and likewise, add more cost due to lost wages.
Worst of all, this
might also result in delays in these patients getting medical care, which could
cause serious, even life-threatening harm. Plus, shorter visits
and less time in the evaluation of illness can lead to
unnecessary testing and hasty prescription-writing, and increase the chances of
medical error.
And, frankly, I’m
concerned for my colleagues as well as my patients. The burnout CMS says it is
trying to curtail could rise instead as doctors feel forced into rushing
patients, and become despondent about possibly providing suboptimal advice and
seeing poor outcomes.
The comment period is
now closed and CMS is in the process of reading the 15,842 public
comments that have been offered to its proposed rule. A
decision is expected on or before November 1st.
Until then, if you
too have an opinion on the issue, it is not too late to write to your
representatives in Congress to let them know what you think.
https://considerable.com/impact-of-new-medicare-rule-on-doctor-pay/
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