PhD/PsyD More Medicare sadness

[Sanman]

Finalized cuts for 2021

I will just leave this wonderful Christmas present from CMS here and go yell into a pillow somewhere.

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[WisNeuro]

Looks like I'll be opting out of medicare sooner than I thought. Good thing my IME dance card is filling up quite nicely.

 

[Sanman]

Looks like I'll be opting out of medicare sooner than I thought. Good thing my IME dance card is filling up quite nicely.

What, are you not looking forward to a -10.2% promotion? Sadly, 2020 has made me look incredibly smart to my geropsych friends for my jump to the VA.

 

[WisNeuro]

It's a good year to be going into PP.

 

[Sanman]

It's a good year to be going into PP.

It a great year to be starting something, less so to be established. If I were more motivated, it would be a great time to poach some of my old facility contacts, hire someone to carry a laptop around for me, and do tele-health sessions.

 

[erg923]

hire someone to carry a laptop around for me, and do tele-health sessions.

How heavy is your laptop?

 

[Sanman]

How heavy is your laptop?

Too heavy for my dainty little hands that are not willing to risk COVID by going into an LTC to make an extra buck. However, there are plenty willing to risk it for much less cash that can enter a facility for me.

What I really need is this, Sheldon was a genius:

 

[Ollie123]

Might be done doing paid clinical work within the next 6-18 months. Didn't know about this when I was pursuing it, but seems like good timing.

 

[WisNeuro]

Might be done doing paid clinical work within the next 6-18 months. Didn't know about this when I was pursuing it, but seems like good timing.

It's not terrible for doing therapy, it's really bad for assessment though.

 

[PsyDr]

Saw that coming. Planned accordingly.

It's not terrible for doing therapy, it's really bad for assessment though.

It’s a LOT worse, because it doesn’t account for inflation. In 2025, you’re making 10% less ... in 2020 dollars. So your purchasing power is like 30-40% less.

Saw this coming. Planned accordingly. Same as 2009. They reduce the incomes of the lower rungs, put some pressure on, then offer to make them employees at a lower but steady rate. Go call X insurance right now. They've replaced their phone’s “hold” music with information. It offers telemedicine mental health providers, which are employed by that insurance company.

Invest heavily in stuff that the new worker class will need. Look at what "luxuries" are being marketed to those peeps, which serves as evidence that they definitely haven't just been screwed. Wait to invest in worker class media, like rap, that newly disenfranchised use to exclaim how they still retain power and relevance (e.g., Brit punk 1977-1980, actual gangster rap 1990-2000, that Salsford rap right now, but excluding any iteration that has the adoption of consumerism).

 

[R. Matey]

Another argument against taking insurance and for looking into to alternate forms of revenue.

 

[Therapist4Chnge]

I stopped taking Medicare 3+ yrs ago and I miss it zero percent bc of such disrespectful cuts like this. I refuse to support a group that stopped supporting us decades ago. It's a shame people have to wait longer, but many clinicians cannot afford to see Medicare patients...*especially* for assessment work.

Thankfully my IME work is booming, and I'm already booking into the Spring & summer for court cases. I will continue to carry a clinical caseload, but I'm much pickier about the types of cases I accept.

 

[thebalmofhurtminds]

Salt in the wound that I'm adjunct with our Neurology Department and keep getting e-mails urging Congress not to delay in passing this. I know everyone's gotta do what they gotta do for their own bottom line but oof.

 

[DynamicDidactic]

Invest heavily in stuff that the new worker class will need. Look at what "luxuries" are being marketed to those peeps, which serves as evidence that they definitely haven't just been screwed. Wait to invest in worker class media, like rap, that newly disenfranchised use to exclaim how they still retain power and relevance (e.g., Brit punk 1977-1980, actual gangster rap 1990-2000, that Salsford rap right now, but excluding any iteration that has the adoption of consumerism).

I'm so confused.

 

[cara susanna]

Wait, so it sounds like it's actually a good thing with respect to therapy rates, right?

 

[WisNeuro]

Wait, so it sounds like it's actually a good thing with respect to therapy rates, right?

Generally, yes. Here are some numbers in terms of RVUs

2020 2021
90832 1.5 1.7
90834 2.0 2.24
90837 3.0 3.31

Though, I believe that they also changed the conversion factor for non E/M codes, so I'd need to find that to see if it's still actually a decrease.

 

[Sanman]

Wait, so it sounds like it's actually a good thing with respect to therapy rates, right?

So, because psychiatry, the psychotherapy rates will be getting a bump of a certain percent is my read. That means instead of a 10.2% cut maybe a 5% or 8% cut. So 10.2% overall cut, but then maybe a 5% bump or something. So maybe a net cut of ONLY 5.2%. At least that is my read. We will have to see how the numbers shake out.

 

[WisNeuro]

So, because psychiatry, the psychotherapy rates will be getting a bump of a certain percent is my read. That means instead of a 10.2% cut maybe a 5% or 8% cut. So 10.2% overall cut, but then maybe a 5% bump or something. So maybe a net cut of ONLY 5.2%. At least that is my read. We will have to see how the numbers shake out.

Ok, so the 2020 PFS conversion rate from RVU to reimbursement was 36.09, the 2021 PFS RVU conversion rate will be 32.41 if I am reading correctly, so that's...not great

 

[cara susanna]

That's irritating. Even if the reimbursement rates don't affect me as a VA employee, the RVUs do.

 

[WisNeuro]

That's irritating. Even if the reimbursement rates don't affect me as a VA employee, the RVUs do.

Well, if you are primarily therapy, your RVUs will be better, the conversion rate goes into how much we get reimbursed.

 

[WisNeuro]

So, essentially the cuts were the conversion factor, with some codes spared somewhat by increasing their wRVUs. Assessment codes wRVUs remained the same, but the conversion factor eats into the reimbursement pretty heavily.

Not great for non-VA systems as the assessment specialists were the ones still being hired.

 

[WisNeuro]

As yet another plug for being a member of your state association and APA, apathy and lack of money to lobby is part of this. The number of psychologists who offered comment was tracked. We at the state level worked on this and it was like herding cats to get people to take 5-10 minutes to do the bare minimum. If we keep up this level of participation, you can look forward to more double digit cuts in the future.

 

[Sanman]

That's irritating. Even if the reimbursement rates don't affect me as a VA employee, the RVUs do.

Even being VA employees, it is never good to be pigeon-holed onto a job because the the system at large is not viable for us. Given the hit to the middle-class at large, private pay will be less of an option for many would be clients. With reimbursement rates decreasing for CMS, that is another Avenue being cut off.

 

[Sanman]

As yet another plug for being a member of your state association and APA, apathy and lack of money to lobby is part of this. The number of psychologists who offered comment was tracked. We at the state level worked on this and it was like herding cats to get people to take 5-10 minutes to do the bare minimum. If we keep up this level of participation, you can look forward to more double digit cuts in the future.

I wish it were that simple. In reality, we got our as*es handed to us by the AMA and CMS working together. So did physical therapists and some other allied health professions. Not sure anything would have helped. The AMA will always be a behemoth compared to us.

 

[WisNeuro]

I wish it were that simple. In reality, we got our as*es handed to us by the AMA and CMS working together. So did physical therapists and some other allied health professions. Not sure anything would have helped. The AMA will always be a behemoth compared to us.

It's not that simple, but when we get to about 33% of the national goal in terms of comments, that certainly didn't help. Hamstringing our lobbying efforts due to lack of funds also doesn't help. Giving up the fight before the battle has even begun is part of why we're in this situation.

 

[Therapist4Chnge]

Psychologists are experts at expecting others to protect our profession, yet we are continually shocked every time we lose ground to mid-level scope creep or have our reimbursements slashed by CMS.

 

[PsyDr]

Psychologists are experts at expecting others to protect our profession, yet we are continually shocked every time we lose ground to mid-level scope creep or have our reimbursements slashed by CMS.

It's cool, all you have to do is say, "SOMEONE should do something!". Poof! Anxiety is gone. Thoughts and prayers. It's not like the thought process has any relationship to 65 year old psychologists telling everyone that they trained under someone famous 43 years ago.

It's like that's a complex thought process related to fathers. But we should probably shorten that term to something useable. Like "Father Complex". Too bad the psychoanalysts didn't write about this. We could really use some insights from Freud, Jung, Neuman, and maybe a modern guy like James Herzog.


ALTERNATELY,

O