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Fewer Medicare Patients for Specialists Due to Consult Code Cuts

Cheryl Clark, for HealthLeaders Media, July 19, 2010

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."

 

 


Cheryl Clark is senior quality editor and California correspondent for HealthLeaders Media. She is a member of the Association of Health Care Journalists.
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