Medicare cuts 2022

This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.

Sanman

O.G.
Joined
Sep 2, 2000
Messages
5,400
Reaction score
8,147
It's that time of year.Make your voice heard and tell your friends, family, and colleagues to do so as well.

Medicare reimbursement rates for psychologists’ services will be cut 3.75% starting in January unless Congress takes action.

Take Action

Members don't see this ad.
 
  • Like
  • Wow
Reactions: 1 users
Done! I felt fancy getting to put "Dr." for the first time.
 
  • Like
Reactions: 4 users
Members don't see this ad :)
1) Inflation is up by about almost 7% this year.
2) Social security gives out cost of living raises, and they're getting about a 6% pay INCREASE this coming year.
3) Instead, we are getting about a 4% pay cut. Except it's not 4%. It about ELEVEN PERCENT (e.g., You get paid $100/hr for psychotherapy. Every week you treat yourself to a $100 meal. In 2022, you're making $96/hr while that meal is $107. That's an $11 difference).
4) Except consumer prices exceed inflation, interest rates are due to rise in 2022, and energy futures are up 11-49%.

TL; DR: Things are about to get interesting.
 
  • Like
Reactions: 2 users
1) Inflation is up by about almost 7% this year.
2) Social security gives out cost of living raises, and they're getting about a 6% pay INCREASE this coming year.
3) Instead, we are getting about a 4% pay cut. Except it's not 4%. It about ELEVEN PERCENT (e.g., You get paid $100/hr for psychotherapy. Every week you treat yourself to a $100 meal. In 2022, you're making $96/hr while that meal is $107. That's an $11 difference).
4) Except consumer prices exceed inflation, interest rates are due to rise in 2022, and energy futures are up 11-49%.

TL; DR: Things are about to get interesting.

Good thing my IME hourly rates go up a good amount at the end of the year to compensate :)
 
  • Like
Reactions: 1 user
1) Inflation is up by about almost 7% this year.
2) Social security gives out cost of living raises, and they're getting about a 6% pay INCREASE this coming year.
3) Instead, we are getting about a 4% pay cut. Except it's not 4%. It about ELEVEN PERCENT (e.g., You get paid $100/hr for psychotherapy. Every week you treat yourself to a $100 meal. In 2022, you're making $96/hr while that meal is $107. That's an $11 difference).
4) Except consumer prices exceed inflation, interest rates are due to rise in 2022, and energy futures are up 11-49%.

TL; DR: Things are about to get interesting.
Pretty much. This has been the trend for the last 20 years on a smaller level. The changes to telehealth are the only thing that help to salvage these issues as rent is a large part of overhead for most practices.
 
  • Like
Reactions: 1 users
Dumb question that shows how little I know about insurance and reimbursement rates: will this impact RVUs?
 
Dumb question that shows how little I know about insurance and reimbursement rates: will this impact RVUs?

It will mildly INCREASE RVU values ,but decrease reimbursement. They are literally saying that the work is harder, but should be paid less.
 
  • Like
Reactions: 2 users
Thanks again for the head's up, Sanman. Just received this:

Thank you for your advocacy this week – you helped secure an important victory for mental health access by preventing substantial Medicare cuts from taking effect in January!

Today the Senate approved legislation to prevent millions of dollars in Medicare payment cuts to psychologists next year.
The Protecting Medicare and American Farmers from Sequester Cuts Act would largely eliminate harmful cuts to Medicare rates for psychologists, and delay other automatic reductions scheduled for January 1st. This legislation is now going to President Biden to be signed into law.

By protecting Medicare mental health services reimbursements, the legislation helps ensure the program and its providers can continue meeting the needs of Medicare beneficiaries, including vulnerable populations.
The COVID-19 pandemic has been taking a heavy toll on the nation’s mental health, with psychologists reporting large increases in demand for treatment of anxiety and depression compared with last year, and increased workloads and longer waitlists than before the pandemic.

The fight is not over, as the Medicare cuts have only been postponed, not eliminated. We will keep you informed on ways to continue to take action to protect access to mental health in 2022, but yesterday’s vote was a significant step forward in supporting psychologists and their patients.

We could not have done it without you – thank you for your work to elevate the voice of psychologists. We hope you will continue to join our future efforts.

Sincerely,

Katherine B. McGuire
Chief Advocacy Officer
 
  • Like
Reactions: 4 users
Members don't see this ad :)
Thanks everyone. I know it can seem tedious, but taking a few minutes to do things like this here and there really does add up. Please continue to support your state and federal advocacy efforts.
 
  • Like
Reactions: 5 users
Sounds about right.

I suspect this will result in raises to RVU/wRVU targets in the relatively near future.

Most employers will do that, citing reimbursement changes. Then they will offer employees a "cost of living" raise of 3%. But an actual COL raise should be 7%, based on inflation in 2021. In essence, "I'm either getting a 7% raise to keep my purchasing power the same, or I'm not working additional RVUs.".

This is one of the reasons I won't be anyone's employee. The employer says "we need you to work 10% harder". Then I ask, "Where is that in my contract? Or are you voiding the contract by asking for additional services without giving me additional consideration?". Then it's all, "Psydr is hard to work with.....".

LOL.
 
  • Like
Reactions: 7 users
Most employers will do that, citing reimbursement changes. Then they will offer employees a "cost of living" raise of 3%. But an actual COL raise should be 7%, based on inflation in 2021. In essence, "I'm either getting a 7% raise to keep my purchasing power the same, or I'm not working additional RVUs.".

This is one of the reasons I won't be anyone's employee. The employer says "we need you to work 10% harder". Then I ask, "Where is that in my contract? Or are you voiding the contract by asking for additional services without giving me additional consideration?". Then it's all, "Psydr is hard to work with.....".

LOL.
Come on, be a "team player"
 
  • Haha
  • Like
Reactions: 3 users
Most employers will do that, citing reimbursement changes. Then they will offer employees a "cost of living" raise of 3%. But an actual COL raise should be 7%, based on inflation in 2021. In essence, "I'm either getting a 7% raise to keep my purchasing power the same, or I'm not working additional RVUs.".

This is one of the reasons I won't be anyone's employee. The employer says "we need you to work 10% harder". Then I ask, "Where is that in my contract? Or are you voiding the contract by asking for additional services without giving me additional consideration?". Then it's all, "Psydr is hard to work with.....".

LOL.

I mean you are hard to work with....you are not wrong...but you are hard to work with. Why can't you just do as you are told? Lol

When you stop listening to people's words and start listening to people's actions, a lot of people get caught with their pants down. This might be why I am starting to develop a reputation for being difficult to work with as well.
 
Medicare sucks. If I ever get back into PP / consulting in any serious way (and since I'm in gero - it's overwhelmingly going to be dealing with Medicare recipients), I'm for sure going to be opting out of that bull****.
 
Medicare sucks. If I ever get back into PP / consulting in any serious way (and since I'm in gero - it's overwhelmingly going to be dealing with Medicare recipients), I'm for sure going to be opting out of that bull****.

At least for neuro testing, while it's onerous to setup credentialing. Medicare is the easiest to bill and work with, and similar in reimbursements to many of the insurers round here. Now, clinical is only about a quarter to third of my revenue, but ease of billing and such can be an important factor.
 
At least for neuro testing, while it's onerous to setup credentialing. Medicare is the easiest to bill and work with, and similar in reimbursements to many of the insurers round here. Now, clinical is only about a quarter to third of my revenue, but ease of billing and such can be an important factor.
Interesting. Do you consult at SNFs? Where do you see your Medicare recipients? Although I'm not neuro, I've been trained in - and do a lot of testing. I could see a route for a practice where I do a lot of capacity and brief-er cognitive assessments.
 
Interesting. Do you consult at SNFs? Where do you see your Medicare recipients? Although I'm not neuro, I've been trained in - and do a lot of testing. I could see a route for a practice where I do a lot of capacity and brief-er cognitive assessments.

Pure OP neuropsych evals, about 70% dementia evals.
 
  • Like
Reactions: 1 user
Medicare sucks. If I ever get back into PP / consulting in any serious way (and since I'm in gero - it's overwhelmingly going to be dealing with Medicare recipients), I'm for sure going to be opting out of that bull****.

The problem with SNF consulting is not medicare, but that we can't appropriately bill for the really tough behavioral stuff that we are capable of doing. I really can't see the benefit to SNF consulting over regular PP given the added complexity of the population for straight outpatient pay. The other issue is corporate instrusion into this area of practice.
 
  • Like
Reactions: 1 user
Pure OP neuropsych evals, about 70% dementia evals.
That's cool. That's similar to what I would want to do (albeit with a lot of caregiver support intervention stuff in addition)
The problem with SNF consulting is not medicare, but that we can't appropriately bill for the really tough behavioral stuff that we are capable of doing. I really can't see the benefit to SNF consulting over regular PP given the added complexity of the population for straight outpatient pay. The other issue is corporate instrusion into this area of practice.
For sure! I love long-term care psychology but the really impactful stuff, like you say, is **** when it comes to billing.
 
That's cool. That's similar to what I would want to do (albeit with a lot of caregiver support intervention stuff in addition)

For sure! I love long-term care psychology but the really impactful stuff, like you say, is **** when it comes to billing.

This is where you may run into roadblocks with billing/reimbursement. It's a noble cause, but I'm done with volunteering a lot of my time these days. I'm focusing on getting paid over the next few years.
 
This is where you may run into roadblocks with billing/reimbursement. It's a noble cause, but I'm done with volunteering a lot of my time these days. I'm focusing on getting paid over the next few years.
This is one of those things I think we should be charging cash consultation for rather than bundling in with testing.
 
This is one of those things I think we should be charging cash consultation for rather than bundling in with testing.

In outpatient testing, you can roll some of this into your feedback and increase your 96133 billing if you do it right, but that's a one-shot, not ongoing support. I agree, though, depending on how you structure it, may be better to just run a group format and charge a certain cash fee.
 
This is one of those things I think we should be charging cash consultation for rather than bundling in with testing.
That's what I was thinking as well, perhaps of the SNF itself if possible (although I have my doubts they'd pay for it). If nothing else, perhaps consultation regarding training mid-level staff to provide those services in an ongoing manner for families, and then help oversee it as needed.

It's the type of thing in a memory/dementia clinic format I could see a social worker helping to facilitate while integrating other case management components like connections with community resources.

In a perfect world, anyway. But even cash pay from patient's families to help get some training and support in that regard. The group intervention idea is a good one as well. VA had a manualized group-specific dementia intervention program or two that I'd always hoped to one day implement but never did.
 
That's what I was thinking as well, perhaps of the SNF itself if possible (although I have my doubts they'd pay for it). If nothing else, perhaps consultation regarding training mid-level staff to provide those services in an ongoing manner for families, and then help oversee it as needed.

It's the type of thing in a memory/dementia clinic format I could see a social worker helping to facilitate while integrating other case management components like connections with community resources.

In a perfect world, anyway. But even cash pay from patient's families to help get some training and support in that regard. The group intervention idea is a good one as well. VA had a manualized group-specific dementia intervention program or two that I'd always hoped to one day implement but never did.

SNFs have been mandated to do this since the late 70s. The problem is that since no one gets paid to it, it often gets short shrift. They all have a short 'in house' training for CNAs and other staff and will document something in the care plan. Beyond that, I have provided many in sevices (free of charge) to many partner facilities. That is about they it ends with education. The good places will have a good individual behavioral plan for a pt. However, I was often under billing or just plain writing off my time for that stuff.

At this point, I am more interested in working with families that have the resources than in hoping facilities will dig into their coffers. Not sure where @JeyRo stands on the subject.

I have also been doing some general MH stuff since the pandemic started and forgot how much easier it is to work with the more functional patients. Always an option for PP.
 
Last edited:
SNFs have been mandated to do this since the late 70s. The problem is that since no one gets paid to it, it often gets short shrift. They all have a short 'in house' training for CNAs and other staff and will document something in the care plan. Beyond that, I have provided many in sevices (free of charge) to many partner facilities. That is about they it ends with education. The good places will have a good individual behavioral plan for a pt. However, I was often under billing or just plain writing off my time for that stuff.

At this point, I am more interested in working with families that have the resources than in hoping facilities will dig into their coffers. Not sure where @JeyRo stands on the subject.

I have also been doing some general MH stuff since the pandemic started and forgot how much easier it is to work with the more functional patients. Always and option for PP.

That seems to be the most feasible option going forward, yep.
 
Top