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Fewer Medicare Patients for Specialists Due to Consult Code Cuts

 |  By cclark@healthleadersmedia.com  
   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.

As a result, large percentages of respondents say they have changed their practices in the following ways to compensate for the reduced pay:

 

 

  • Nearly three in four physicians responding said their Medicare billings had reduced total revenue by more than 5%
  • One in three said revenue is down by more than 15%.
  • One in three has eliminated staff, including physicians in some cases.
  • Three in 10 have reduced services to Medicare patients or are contemplating cost-cutting steps that impact care.
  • Two in five are deferring the purchase of new equipment or information technology.
  • Because CMS no longer requires specialists to provide referring primary care physicians with a written report on the results of the consultation, about 6% have stopped providing these reports, and another 20% plan to stop providing them.

     

    Survey respondents included members of specialty societies in allergy, asthma and immunology; neurology; otolaryngology; clinical endocrinology; cardiology; gastroenterology; rheumatology; gastroenterology; psychiatry; clinical oncology; gastrointestinal endoscopy; hematology; urology; heart rhythm; infectious diseases; cardiovascular angiography, and endocrinology.

    Mazer shares concerns from many specialists that commercial health plans will also eliminate consult codes, exacerbating the problem.

    In a letter last month to CMS, these 17 specialty societies and another 16 professional physician organizations, said the AMA survey disproves federal officials' contention last year that Medicare revenues would decline by no more than 3%.

  • At the time, CMS said it believes is no significant difference between a consultation and a routine office visit because specialty consultants now can send referring physician the medical record rather than a written report.

    That's faulty logic, the doctors say, because it discourages the care coordination improvements that both Congress and CMS seek as part of health reform, they wrote.

    "The CPT system that Medicare codes are built on counts both the face to face time and not other services such as establishing and reviewing charts and communicating with families and other health care professionals," the professional groups said in their letter to CMS. "However, CMS only recognizes face to face time and time and not other services such as establishing and reviewing charts and communicating with families and other health care professionals.

    "In effect, Medicare is denying payment for these services and further discouraging coordination of care between professionals," the groups wrote.

    The specialist societies said the under-reimbursement problems could be mitigated by creating some mechanism for compensating consultant physicians for preparing a comprehensive report for the referring physician.

    It is unclear how CMS will respond.

    Mazer summed up: "There appears to be a breaking point beyond which resources cannot be stretched without cutbacks on access and ancillary services, and we have reached that point in access to specialty care, based on this survey."

     

     

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