1. Download free Tapatalk for iPhone or Tapatalk for Android for your phone and follow the SDN forums with push notifications.
    Dismiss Notice
Dismiss Notice
Hey Texans—join us for a DFW meetup! Click here to learn more.

Urge your representatives to increase PCP reimbursements recommended by MedPac

Discussion in 'Family Medicine' started by MedicineDoc, May 9, 2008.

  1. MedicineDoc

    5+ Year Member

    Joined:
    Feb 13, 2008
    Messages:
    546
    Likes Received:
    8
    http://www.ama-assn.org/amednews/2008/05/05/gvsa0505.htm

    GOVERNMENT & MEDICINE

    MedPAC advises raising primary care pay


    By David Glendinning, AMNews staff. May 5, 2008.
    Washington -- Primary care doctors would receive higher Medicare payment rates under a proposal that a panel of congressional advisers will send to Capitol Hill in June, but at least one lawmaker is considering such a plan before the proposal even arrives.

    Medicare Payment Advisory Commission members are worried about a growing primary care physician shortage and fear that fewer new doctors are going into primary care because of the relatively low rates that Medicare pays for their services. MedPAC found that nearly 30% of beneficiaries who are looking for a new primary care physician report difficulty in doing so.Boosting rates to those types of physicians could help address the problem by acting as a financial incentive, MedPAC decided at its April meeting in Washington, D.C. "Primary care services have become undervalued over time, and thus they risk becoming under-provided," MedPAC senior analyst Cristina Boccuti told the panel.
    As a result of a review of how much it pays for each Medicare treatment, the Centers for Medicare & Medicaid Services in 2006 decided to boost the relative values it assigns to some of the types of services that primary care physicians often provide. The MedPAC proposal would go one step further by designating individual doctors as primary care or non-primary care physicians and allowing members of the first group to use a special modifier on their claims. The modifier would garner higher rates for evaluation and management services.
    MedPAC likely will advise giving the administration much of the say over which doctors can use the modifier. Under one scenario, the Dept. of Health and Human Services would start with physicians who designate themselves as generalists and then target the subset who provide primary care the majority of the time.
    Another option would have HHS base the rate add-on solely on how often doctors provide primary care services. This would allow specialists who offer a lot of primary care to get the extra pay.
    MedPAC also voted to recommend that Medicare give additional monthly payments to physicians who provide a "medical home" for chronically ill beneficiaries. The program is already involved in a limited medical home pilot project, and MedPAC will urge that Medicare take it nationwide.
    Physicians divided

    Senate Finance Committee Chair Max Baucus (D, Mont.) is not waiting for the official MedPAC report to arrive on his desk before putting some of its recommendations on the table.
    During an April 11 meeting with several medical specialty organizations, Baucus floated a Medicare physician payment package that he hopes to bring to the Senate floor in May. In addition to stopping upcoming across-the-board cuts for 18 months, Baucus hopes to include a primary care rate boost and a medical home project expansion. But because of Medicare budget neutrality rules, putting more money into primary care would necessitate payment cuts for other doctors. This was the case when CMS approved the relative value changes in 2006.
    Nearly 30% of Medicare beneficiaries report trouble finding a primary care doctor.

    The American Medical Association convened the group that recommended those relative value changes. It supports further improvements to primary care physician pay, said AMA Board of Trustees Chair Edward L. Langston, MD. But Congress should commit additional funds to Medicare so that cuts to other doctors are not needed, he said.
    "Unfortunately, Medicare required the [relative value] increases to be budget neutral, which led to across-the-board reductions for all physicians, including primary care," Dr. Langston said. "Rather than another budget-neutral change that robs Peter to pay Paul, Congress should fund investments in the primary care infrastructure with additional funds."
    Several physician organizations attending the Baucus meeting applauded his plan, despite its tradeoff. In an April 17 letter to Baucus, the leaders of the American Academy of Family Physicians, the American College of Physicians and the American Osteopathic Assn. wrote that Medicare pay increases focused on primary care doctors would help address the shortage.
    "We look forward to working with you on the initial steps that can be taken now to provide such targeted primary care payment increases, recognizing that such increases may fall within current Medicare fee schedule budget-neutrality rules," the letter states. "Over the longer term, we believe that new ways are needed to fund primary care that take into account the evidence that primary care is associated with better outcomes and lower utilization of services covered under other parts of Medicare."
    Physicians who would be on the other side of this equation reject the approach and warn that the goal of bolstering primary care could have unintended negative consequences if not done properly.
    Virtually no radiologist would qualify for a primary care add-on or an evaluation and management rate boost under the MedPAC or Baucus plans, said Arl Van Moore, MD, chair of the American College of Radiology's board of chancellors. Thus, the more physicians are able to capture the extra dollars, the more Medicare would need to slash imaging payments. Medicare services, such as mammography, could become more difficult to access if the rate reductions take too big a bite, he said.
    In recent years, radiologists received two blows to their payment rates through the CMS relative value adjustments and an imaging cut package approved by Congress. They fear that this proposal would be strike three, Dr. Moore said. ACR is seeking a solution that is more equitable to more specialties. "This pits one specialty against another," he said. "These proposals tend to divide medicine."
    Surgeons also are worried about the consequences of shifting money to primary care based on a gut reaction to reports of a physician shortage, said Karen R. Borman, MD, professor of surgery at University of Mississippi Medical Center and a MedPAC member. The most recent CMS relative value update, for instance, shifted more money into primary care services than Medicare pays for all services in five surgical specialties combined.
    Another such boost could cause increases in the volume of services in areas where spending is already on the rise and punish those who are keeping their spending in check, she said.
     
  2. Note: SDN Members do not see this ad.

  3. MedicineDoc

    5+ Year Member

    Joined:
    Feb 13, 2008
    Messages:
    546
    Likes Received:
    8
  4. Blue Dog

    Blue Dog Fides et ratio.
    Physician Gold Donor SDN Advisor Classifieds Approved 10+ Year Member

    Joined:
    Jan 21, 2006
    Messages:
    11,529
    Likes Received:
    3,802
    Status:
    Attending Physician
  5. HeyDoc

    HeyDoc Junior Member
    10+ Year Member

    Joined:
    Jan 10, 2004
    Messages:
    27
    Likes Received:
    0
    Bump, stop whining on the boards about compensation and do something.
     
  6. Blue Dog

    Blue Dog Fides et ratio.
    Physician Gold Donor SDN Advisor Classifieds Approved 10+ Year Member

    Joined:
    Jan 21, 2006
    Messages:
    11,529
    Likes Received:
    3,802
    Status:
    Attending Physician
  7. McDoctor

    McDoctor Over One Billion Cured
    5+ Year Member

    Joined:
    Feb 13, 2006
    Messages:
    656
    Likes Received:
    5
    Status:
    Attending Physician
    Only a minority of relatively new Family Medicine graduates are in a solo practice or partnership position wherein reimbursement has much of a direct impact in their salary. (Multispecialty practices are content to piggyback to overpaid specialists). There is an indirect benefit, but their employers will see more benefit before they will. The current system stifles the opportunity for new graduates to compete, primarily because credentialing processes are insane. Until the system changes in a way which fosters more independent family medicine offices, and makes "hanging a shingle" more feasible for recent grads, the majority of primary care docs aren't going to care about reimbursement in a meaningful way other than to b*tch on these boards.

    For students, interns, and residents, I advocate lobbying for changes which foster more competition, one-time tax breaks for new physicians opening a practice or mandating easier credentialing processes, before getting hung up on reimbursement. Don't get caught up in the group-think that says "more reimbursment at all costs"...you won't have an opportunity to compete for it anytime soon anyway.
     
  8. MedicineDoc

    5+ Year Member

    Joined:
    Feb 13, 2008
    Messages:
    546
    Likes Received:
    8

    It sounds like you are saying you want to open a private practice so that you can compete but want to do it before reimbursements are increased through legislative changes in regulations. You then state that multispecialty centers are paying primary care docs more than they get reimbursed for by having them around so that they can make referrals (where the money comes from). According to your own statements wouldn't you stand to lose money by "hanging a shingle" prior to a potential increase in reimbursements. It justs doesn't make sense. If PCP reimbursements increase I have no doubt that PCPs will find a way to receive that money regardless if it means changing where and with who they go into business.
     
  9. McDoctor

    McDoctor Over One Billion Cured
    5+ Year Member

    Joined:
    Feb 13, 2006
    Messages:
    656
    Likes Received:
    5
    Status:
    Attending Physician
    I'm saying that if reimbursements increased next year, I wouldn't see a difference financially. My employment situation is very typical of most family docs.

    This is why reimbursement won't change, because family docs in an employment or multispecialty model indirectly reap the rewards of overpaid specialists, and therefore have little incentive to do more than lip-service to change their own reimbursement situation.

    Also, the typical new grad would not be able to get credentialed within 6 months with most payors, and would incur considerable financial losses during that time. there is no mandate that states that major payors have to retroactively reimburse after one is credentialed. This is a bigger hurdle for a new physician than whether or not a 99213 pays $65 or $68, so I don't see why they'd spend alot of time of the reimbursement issue.

    I myself don't want to hang a shingle, and have other interests. I am trying to provide an answer to the question of why more docs don't do more than just "whine about the issue". It's because they are now strong-armed into employment models after residency, and therefore never acquire the incentive to do anything more on the issue.

    Established docs expect the young crowd to push for more reimbursement while they simultaneously continue to contribute to an oligopoly which discourages competition. The typical established doc would prefer to expand his/her practice by hiring a mid-level, or presenting an imbalanced employment opportunity, than extending a partnership opportunity to a new grad, for instance. Also, established docs have no incentive to lobby for changes which ease credentialing processes or open more doors for new grads, because they are already credentialed and these byzantine procedures present a convenient barrier to more competition. Basically, they want their cake and to eat it too.
     

Share This Page