Changes to How Medicare Pays Providers Being Proposed

July 23rd, 2018

Sniffles? Cancer? Under Medicare Plan, Payments for Office Visits Would Be Same for Both

Dr. Angus B. Worthing, a rheumatologist, with a patient, Nevzer Stacey, at his office in Chevy Chase, Md., on Friday. A Trump administration proposal would pay less for complicated office visits under Medicare.CreditErin Schaff for The New York Times


New York Times:  By Robert Pear

WASHINGTON — The Trump administration is proposing huge changes in the way Medicare pays doctors for the most common of all medical services, the office visit, offering physicians basically the same amount, regardless of a patient’s condition or the complexity of the services provided.

Administration officials said the proposal would radically reduce paperwork burdens, freeing doctors to spend more time with patients. The government would pay one rate for new patients and another, lower rate for visits with established patients.

“Time spent on paperwork is time away from patients,” said Seema Verma, the administrator of the Centers for Medicare and Medicaid Services. She estimated that the change would save 51 hours of clinic time per doctor per year.

But critics say the proposal would underpay doctors who care for patients with the greatest medical needs and the most complicated ailments — and could discourage some physicians from taking Medicare patients. They also say it would increase the risk of erroneous and fraudulent payments because doctors would submit less information to document the services provided.

Comments regarding this article from Dr. Thomas Davis, Tom Davis Consulting

CMS is proposing the elimination of evaluation and management levels (the E and M system) in the determination of fees for cognitive work through traditional Fee For Services (FFS) Medicare starting in 2019.  That’s right, a five minute quickie or a one hour in-depth visit—one price.  Think about that, one price.  Instead of gaming the data, doctors will game the patients—and preferentially care for those with simple illnesses.

A chronically ill senior would be crazy to stick with FFS Medicare under this payment model—with a little education, they should flock to Medicare Advantage.  This model (the E and M system) has been around for 40 years, all currently practicing doctors trained under it.

This change is a big, big deal.

For more information on Tom Davis Consulting, visit his website:  He has also written a book, “Telemedicine Confidential—Keeping Your Family Safe”

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