No more E&M?

[gudog]

Just read a newspaper article stating that CMS is proposing to eliminate E&M coding levels and pay a flat rate for new and established Medicare office visits.
Any insight/thoughts would be appreciated.

Link to article: Plan to boost Medicare efficiency sparks fears that care could suffer - Atlanta Journal-Constitution

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[chessknt]

Maybe they should do the same thing for hip replacements no matter how complicated they are? A lot more money to be saved there.

Or maybe they should acknowledge how ****ed E/M coding is and fund the creation of a more accurate cognitive work system instead of thinking the entire field of outpatient medicine fits in to 5 (in reality 3) codes.

 

[mszzeta]

Just read a newspaper article stating that CMS is proposing to eliminate E&M coding levels and pay a flat rate for new and established Medicare office visits.
Any insight/thoughts would be appreciated.

Link to article: Plan to boost Medicare efficiency sparks fears that care could suffer - Atlanta Journal-Constitution

That is really a great idea. No one is going to take care of the most complicated patients and let them die to save money for the brilliant government.

 

[bronx43]

Hopefully this won't pass, but if it does, it's basically the end of outpatient medicine as we know it. If you're getting $93 for a complicated level 4/5 patient, you may as well close shop.

 

[VA Hopeful Dr]

Hopefully this won't pass, but if it does, it's basically the end of outpatient medicine as we know it. If you're getting $93 for a complicated level 4/5 patient, you may as well close shop.

Nonsense, you'll just limit patients to one problem per visit.

 

[Vandalia]

Nonsense, you'll just limit patients to one problem per visit.

Exactly. You can see that coming a mile away. Paying $211 for a Level 5 will quickly become paying $675 for five visits on consecutive days.

 

[bronx43]

Nonsense, you'll just limit patients to one problem per visit.

So, if your patient comes in for DM management, you're going to cut them off when they bring up their chest pain?

 

[VA Hopeful Dr]

So, if your patient comes in for DM management, you're going to cut them off when they bring up their chest pain?

Nope, address the chest pain and come back next week for the diabetes.

 

[chessknt]

Nope, address the chest pain and come back next week for the diabetes.

And then watch your satisfaction scores plummet. Patients dont come back for these second visits and then your dm control drops and now mips is killing you and permanently dents your CMS collections.

That strategy is suicide in the long run, better off not taking any Medicare patients with more than a single problem or referring everyone to a specialist for every problem they have.

 

[CCM-MD]

And then watch your satisfaction scores plummet. Patients dont come back for these second visits and then your dm control drops and now mips is killing you and permanently dents your CMS collections.

That strategy is suicide in the long run, better off not taking any Medicare patients with more than a single problem or referring everyone to a specialist for every problem they have.

Not taking Medicare patients may not be a solution. I bet other payors will adopt similar changes.

 

[VA Hopeful Dr]

And then watch your satisfaction scores plummet. Patients dont come back for these second visits and then your dm control drops and now mips is killing you and permanently dents your CMS collections.

That strategy is suicide in the long run, better off not taking any Medicare patients with more than a single problem or referring everyone to a specialist for every problem they have.

Hardly. Lots of doctors already do that as its more lucrative to see 3 level 3 visits in the time it would take you to do 1 level 4.

 

[Vandalia]

And then watch your satisfaction scores plummet. Patients dont come back for these second visits and then your dm control drops and now mips is killing you and permanently dents your CMS collections.

That strategy is suicide in the long run, better off not taking any Medicare patients with more than a single problem or referring everyone to a specialist for every problem they have.

Do you agree to see every patient within 60 minutes of their call to your office? The ED and urgent care do. Despite all that people still go to their primary care physicians and accept the rules, i.e., you will not be seen immediately (with rare exceptions).

Despite the fact that primary care doesn't see patients immediately, and charge what to the average citizen are exorbitant rates, ("She billed $150 for 5 minutes of conversation..!?!") people still give their PCPs decent satisfaction scores. Primary care folks still manage to have some people compliant with dm control despite the fact that they can't get it tested every morning and evening at their doctor's office and see their physician twice a day. One can certainly argue that charging more than $10 for a visit will hurt the patient satisfaction scores, and not seeing a dm patient twice-a-day every day can theoretically result in less control.

The bottom line is that people adjust to the new reality, especially if they don't have a choice.

 

[VA Hopeful Dr]

Do you agree to see every patient within 60 minutes of their call to your office? The ED and urgent care do. Despite all that people still go to their primary care physicians and accept the rules, i.e., you will not be seen immediately (with rare exceptions).

Despite the fact that primary care doesn't see patients immediately, and charge what to the average citizen are exorbitant rates, ("She billed $150 for 5 minutes of conversation..!?!") people still give their PCPs decent satisfaction scores. Primary care folks still manage to have some people compliant with dm control despite the fact that they can't get it tested every morning and evening at their doctor's office and see their physician twice a day. One can certainly argue that charging more than $10 for a visit will hurt the patient satisfaction scores, and not seeing a dm patient twice-a-day every day can theoretically result in less control.

The bottom line is that people adjust to the new reality, especially if they don't have a choice.

Yep. If this becomes to the rule then every doctor will make the same changes and patients will get used to it. They'll complain that it was better back in the day, but they already do that.

 

[ICmyFuture]

Yeah, as a new Endocrine attending not sure I'm going to like this, will see how it plays out.

 

[bronx43]

Yeah, as a new Endocrine attending not sure I'm going to like this, will see how it plays out.

As a rheumatologist, I don't like this. People will get even more disincentivized from complex autoimmune diseases than they already are. Why see a complex lupus patient when you can knock out 4 stable gout or OA patients?

 

[ICmyFuture]

As a rheumatologist, I don't like this. People will get even more disincentivized from complex autoimmune diseases than they already are. Why see a complex lupus patient when you can knock out 4 stable gout or OA patients?

Agree.

I mean, all those complicated diabetics that primary docs dont seem to have the time and send my way do not equal a level 3, sorry. Maybe I will have to lean more on thyroid in the near future if it becomes an issue.

 

[IMreshopeful]

And then watch your satisfaction scores plummet. Patients dont come back for these second visits and then your dm control drops and now mips is killing you and permanently dents your CMS collections.

That strategy is suicide in the long run, better off not taking any Medicare patients with more than a single problem or referring everyone to a specialist for every problem they have.

This will not be limited to Medicare - nearly every insurance follows suit based on what Medicare likes to do

I think that this will probably lead to more referrals from PCPs and probably end up requiring more clinic visits per day for limited complexity. That idiot misanthrope Varma claims it will save paperwork... not sure if she’s just an idiot or a willful liar

 

[IMreshopeful]

Agree.

I mean, all those complicated diabetics that primary docs dont seem to have the time and send my way do not equal a level 3, sorry. Maybe I will have to lean more on thyroid in the near future if it becomes an issue.

Yeah as a future cardiologist I don’t know how much it will affect since most follow ups are level 3/4 (chronic CHF mgmt, stable angina, arrhythmias, etc) and it’s possible to see a lot of new consults. Curious to find out.

 

[VA Hopeful Dr]

This will not be limited to Medicare - nearly every insurance follows suit based on what Medicare likes to do

I think that this will probably lead to more referrals from PCPs and probably end up requiring more clinic visits per day for limited complexity. That idiot misanthrope Varma claims it will save paperwork... not sure if she’s just an idiot or a willful liar

No, that part I believe. If I don't have to document up to a certain level, I won't. Notes will start to look like they did in the pre-EMR days (except legible since we'll still have EMR).

 

[bronx43]

Yeah as a future cardiologist I don’t know how much it will affect since most follow ups are level 3/4 (chronic CHF mgmt, stable angina, arrhythmias, etc) and it’s possible to see a lot of new consults. Curious to find out.

I would assume most cardiology visits are now billed as 4, since you can add in a ton of diagnoses like CAD, cardiomyopathy, HTN, afib, etc. Level 3s would be few and far between. This new format would likely hurt all the specialists.

 

[Money Moniker]

So this seems like basically a tortured, roundabout way of implementing a massive reimbursement cut more so than a reform for reform's sake. If they had projected this change to be revenue neutral from Medicare's pespective I highly doubt they'd have gone through the trouble. The midlevels though must be salivating over this proposal, so I guess it's also possible the nursing lobby was involved in the discussion.

 

[bronx43]

So this seems like basically a tortured, roundabout way of implementing a massive reimbursement cut more so than a reform for reform's sake. If they had projected this change to be revenue neutral from Medicare's pespective I highly doubt they'd have gone through the trouble. The midlevels though must be salivating over this proposal, so I guess it's also possible the nursing lobby was involved in the discussion.

Midlevels are not benefiting from this, since they are paid like MDs via the FFS system - just a lower percentage.

 

[Money Moniker]

Midlevels are not benefiting from this, since they are paid like MDs via the FFS system - just a lower percentage.

But midlevels were mostly seeing uncomplicated level 2/3 patients not the 4/5 trainwrecks. Under this proposal, the easy visits that midlevels see will be bumped up from $93 to $135 while the trainwrecks that physicians see will be cut from $211 to $135. It's pretty clear that midlevels are a huge winner here, along with the hospital admin who just got a large incentive to hire more of them as the simple stuff they can deal with just got a lot more lucrative.

 

[VA Hopeful Dr]

But midlevels were mostly seeing uncomplicated level 2/3 patients not the 4/5 trainwrecks. Under this proposal, the easy visits that midlevels see will be bumped up from $93 to $135 while the trainwrecks that physicians see will be cut from $211 to $135. It's pretty clear that midlevels are a huge winner here, along with the hospital admin who just got a large incentive to hire more of them as the simple stuff they can deal with just got a lot more lucrative.

I can see more simple things in less time than a midlevel. Heck, I can see more trainwrecks per unit time than a midlevel can simple stuff.

 

[bronx43]

But midlevels were mostly seeing uncomplicated level 2/3 patients not the 4/5 trainwrecks. Under this proposal, the easy visits that midlevels see will be bumped up from $93 to $135 while the trainwrecks that physicians see will be cut from $211 to $135. It's pretty clear that midlevels are a huge winner here, along with the hospital admin who just got a large incentive to hire more of them as the simple stuff they can deal with just got a lot more lucrative.

You're basically just saying that whoever sees more level 2-3s will benefit, and whoever sees more 4-5s will lose out. That's pretty much the sentiment of us all.

The question of whether or not mid-levels see more 2s-3s is dependent on their practice location and specialty. As more and more NPs go into specialties, they will essentially have the same billing pattern as the supervising MDs.

 

[clubdeac]

Wanted to bump this thread. Whatever happened to this proposal. Assuming it didn’t pass since I haven’t t heard anything about it this year

 

[gudog]

Last I saw was they were deferring the decision for one year

 

[Raryn]

Wanted to bump this thread. Whatever happened to this proposal. Assuming it didn’t pass since I haven’t t heard anything about it this year

CMS kicked the can down the road. They'll probably continue to do so for a few years.