Behind the Scenes: Medicare Coding Changes...

Starting January 1, 2010, Medicare implemented a dramatic change to how doctors, and specifically specialists, code your visit to their office, specifically referred to as E & M codes, or Evaluation and Management codes. Up till now, if your primary care doctor or internist referred you to a specialist, he would be required to send a letter requesting the consult and fax your medical chart with his notes to the specialist so he would have them to review when you were seen. After your visit, the specialist would send a letter to the referring doctor explaining his recommendation and plan for you, the patient. These higher level, or "consult codes", reimbursed the specialist a higher amount than the lower level "new patient codes". A patient who came to a specialist's office for a visit but who was not referred by another doctor, would be coded using a "new patient" code, (which has 4 levels), with the level of the visit being determined using multiple factors Medicare has developed. There is no communication required between the specialist and a 'new patient''s other doctors. He does not send his chart notes to any of the physician's you list on your information sheet. This only happens if a specific doctor has requested you see a specialist, usually of his own choosing.

So here is the change....Medicare is not accepting any more consult coded visits. All visits must be coded as a 'new patient visit'. Here is what this means to Medicare.....Medicare can get the same work out of the doctors but pay them less. As medical professionals, the majority of doctors will practice as trained, doing whatever necessitates the appropriate care required for their patients i.e. communicating to the referring physicians. The continued administrative costs associated with corresponding with each other and time required to process a consulting physicians notes will not change, in fact they continue to increase.

Here is what it means to you the patient....there will be doctors who forego communicating with the referring doctor because they are not getting paid for it. Already there are patients and families who are frustrated when they don't get answers. Think about the ramifications when confusion is built into the process because one doctor doesn't know what the other is doing (this already happens sometimes right?) With the elimination of the consult structure, which had been built into the Medicare reimbursement schedule, the incentive for some doctors to communicate with each other will be eliminated. Many of the costs associated with communication between doctors will continue to exist and actually increase. The fact they aren't being compensated for those costs will be enough to propagate practicing medicine in a shoddy way - reduced communication between referring physicians. Bottom line: the quality of healthcare we receive will continue to be eroded, little by little, and most people won't be able to connect the dots. (Where have I heard that before?) But because you are reading this blog, you will! :) Doesn't that make you feel better??

End of Life Legislation - The Crux of the Matter

We have been hearing a lot about a particular component to the healthcare legislation being crafted and that is the End of Life Counseling that will be required for all patients. At one point, the Republicans deemed it a "Government Death Panel" which the Democratics quickly denounced as simply untrue and another political scare tactic. The reality is that End of Life Counseling between patients, their familys and their doctors has been a part of medical care for many years. In the 80's, Eastern Virginia Medical School was one of the first to have a program dealing extensively with end of life issues, dealing with the myriad of ethical and legal dilemmas that are associated with the topic. It was part of the curriculum and training of their students, future doctors, to have these types of conversations with their future patients. This curriculum became a model for other medical schools around the country. I don't know the percentage as a fact to quote, but I suspect that most medical schools have this type of program in place in the 21st century. In addition, most hospitals (and again, I do not have the statistics to say whether 75, 80 or 90 percent) have Ethic Committees where teams of doctors discuss individual cases and address the complex questions end of life issues bring to the table, their commitment to the patient being their number one priority.
And here is the concern: by legislating "end of life counseling", it is a slippery slope to government legislating other aspects of medical care. Many physicans believe there will be no turning back once we allow this foot in the door for direction by the government in this area. It is a point of no return in the fight for physicians to be directing the care of their patients. What we now consider to be a sacred and private relationship between physician and patient will be redefined. It will be you, the government, and your physician. For most private practioners, the doctors in your community, this is the number one issue causing them concern.