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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.
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.
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.
