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Fewer Medicare Patients for Specialists Due to Consult Code Cuts

Cheryl Clark, for HealthLeaders Media, July 19, 2010

Upset about the federal government's elimination of pay for specialty consultations, about one in five physicians has eliminated or cut back on accepting new Medicare patients, according to a survey by the American Medical Association and 17 professional specialist societies.

The AMA says that 7,781 doctors responded, of which 6,911 said they treat Medicare patients and about 5,500 completed most questions, which were distributed between April 12 and April 30 this year.

As of Jan. 1, the Centers for Medicare & Medicaid Services eliminated the special series of five CPT codes that allowed specialist physicians, such as cardiologists, oncologists, and surgeons, to bill for consultations, performed at the request of a practitioner who wants a specialist's opinion regarding his or her patient. Before Jan. 1, those codes allowed doctors to bill between $20 and $50 more than what they would bill under an ordinary office visit.

As predicted by San Diego otolaryngologist Ted Mazer MD last fall, the reduction in specialists' Medicare pay has indeed translated to specialists no longer being available for Medicare patients, according to the AMA survey.

"No one should be surprised by the results of this study, only worried about the implications," says Mazer, who says it's now obvious that Medicare's predictions of minimal impact "were wrong."

"Consults necessarily involve more intense services and coordination of care amongst physicians, in order to evaluate and plan treatment for a medical condition that was seen as beyond the scope of the referring physician," he says.

The respondents, 30% of whom said Medicare patients constitute more than 50% of their patient mix, say that their total revenue stream has decreased because of the polity change.

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