President Obama will no longer play games with the budget – his administration will include the cost of the wars in the budget, will not count the fake ‘savings’ from the SGR process (the Sustainable Growth Rate is the process that ‘cuts’ Medicare payments for doctors every year), and will acknowledge the alternative minimum tax will be adjusted to reduce its potential impact on taxpayers. The President’s predecessor, Mr Bush, routinely took credit for the latter two, all the while knowing the laws to cut doctors’ payments would be suspended and limit the AMT’s impact would be reduced. And Bush funded the wars via special appropriations and not in the annual budget process.
The historical process of kicking the Medicare physician reimbursement problem down the road (to paraphrase Mr Obama) has served to delay the final day of reckoning, while making that reckoning ever more expensive. Legislators, citizens, and regulators must confront that problem this year – and it appears the SGR wiill be addressed this summer.
It looks like reimbursement for cognitive services – the 99xxx codes for readers expert in CPT-4s (thanks for the correction Mr Gordon); office visits and similar services for others – will be increased while payments for surgeries, imaging, and other ‘procedures’ will be reduced.
This just makes sense. Primary care physicians have seen their total compensation slide year after year, while those doctors specializing in ‘specialties’ have seen slight increases. There is a shortage of primary care docs – newly minted physicians can’t afford their debts on $125k a year, so they have to specialize in one of the more lucrative areas if they are to have any hope of a decent income. Increasing reimbursement for cognitive services will also likely lead to a reduction in the number of patients referred to specialists; if your family practice doc can afford to spend the time to talk through lifestyle issues that may be contributing to your diabetes, low back pain, and/or shortness of breath, the two of you may be able to come up with a strategy that doesn’t require treatment by one or more specialists.
Reducing compensation for specialists is going to ignite a political firefight – one that will be loud, violent, and ugly. It is also long overdue. There are going to be winners and losers in health reform, and one group that looks likely to lose is specialists.
What does this mean for you?
By acknowledging the real cost of Medicare physician compensation, the President is being honest with the public about the program’s costs. That honesty is exactly what we need – a clear understanding of the system’s costs and cost drivers.
Tomorrow, we’ll consider the impact of changing physician compensation on managed care plans.
Feb
23
Alas, the 99xxxx codes are CPT (procedure, more or less), not ICD (diagnosis and a bunch of other stuff, not counting inpatient surgeries).
I could write a book about those things. Among other things, I believe the E&M codes, created to help primary care, destroyed primary care.
See: http://notes.kateva.org/2009/01/health-care-reform-be-humble-be-afraid.html
As I said in a different post:
The concept that specialist and generalist (i.e., internal med., family med., peds.) pay will/should equal out over time is absurd. Most specialists have many more years of more difficult training (during which they make very, very little) than generalists, they have much higher malpratice premiums and operating expenses and often much worse/irregular hours. If anyone thinks that a cardio-thoracic surgeon (minimum of 7 very tough years post med school training) will work for an internist’s (three years, much easier) wages than they are sadly mistaken.