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AMA Cries for More Cash to Ensure Quality Care

Philip Betbeze, for HealthLeaders Media, October 14, 2011

The American Medical Association wants the Centers for Medicare & Medicaid Services to start paying doctors extra for care coordination. The group argues in a letter to CMS administrator Donald Berwick that four types of care coordination services should be reimbursed separately from the office visit to ensure physicians are compensated for providing these services.

Before I criticize their position, I want to note that their argument, on its face, is sound. Care coordination, in many cases, does prevent more expensive hospital care down the road. That's because, in theory, patients aren't made sicker because of poor communication among their various doctors, usually one or more specialists in addition to a primary care physician.


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The idea is to get all the providers actually communicating with each other instead of each operating within their own silos, thereby possibly endangering the patient with incompatible drugs, treatments, or conflicting advice.

And taking care of these kinds of patients is more difficult and time consuming than treating healthier ones, while both are reimbursed at the same rate. But that's where my agreement with their position ends.

Excuse me, but as physicians sworn to do no harm, isn't this kind of work what they should be doing already? The presupposition in their argument is that physicians' responsibility for overall quality patient care begins and ends at coding.

To take their argument further, perhaps they should be reimbursed separately for writing a prescription when the patient is not in the room? The fact that many physicians don't currently coordinate care is just one indication of why our national healthcare bill is frighteningly large and rapidly growing larger. Of course, patients have some responsibility for coordinating their own care, but clearly, most don't have the ability to do this job on their own.

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5 comments on "AMA Cries for More Cash to Ensure Quality Care"


American Medical Association (10/17/2011 at 3:14 PM)
The recommendation to CMS on reimbursing for coordinated care services was made by a committee of physicians and others (not directly by the AMA). They are seeking to have these critical services, which physicians often already perform, encouraged, recognized and reimbursed by Medicare. We agree with the author that the Medicare payment system is broken and fragmented. The AMA does support stabilizing the Medicare system, where low reimbursement rates and the ongoing threat of severe cuts from the broken Medicare physician payment formula are already forcing 1 in 5 physicians to limit the number of Medicare patients in their practices. Even by the government's own conservative estimate, Medicare payments for physicians are low, with physicians now operating at a 20 percent gap between Medicare's payment updates and the increasing cost of caring for seniors. The AMA is working to make sure Congress enacts permanent repeal of the broken formula and protects access to care for patients. We support enacting a five-year period of stable Medicare physician payments during which time new models of care delivery, which have the potential to coordinate care and reduce costs, can be tested. These new models should form the basis for an improved system as we move Medicare forward.

ps (10/17/2011 at 10:00 AM)
First airlines, then hotels, and now AMA is taking out a chapter from airlines' book of de-bundling services that were supposed to be the part of their contract to provide healthcare. If this is approved, then ALL healthcare providers will follow. There goes our idea for an affordable and accesible healthcare for all Americans down the drain!

mc (10/14/2011 at 8:21 PM)
Thanks so much for Mr. Betbeze's article in HealthLeaders Media entitled, "AMA Cries for more Cash to Ensure Quality Care". His description was insightfully accurate. The more reimbursement-driven our healthcare is becoming, the less patient-centered it is. The situation, especially in our hospitals, is frightening. That we have come to a point where, in order for a healthcare institution or physician to care, we have to first provide a reimbursable situation, clearly outlines the fractured state of healthcare today. Healthcare is becoming less and less individualized, despite all the esoteric reimbursement strategies that are in place in order to show it isn't. Excellent article.