Stanley Feld M.D., FACP, MACE Menu


President Obama. You Are Losing Your Workforce.


Stanley Feld M.D.,FACP,MACE  Somehow, President Obama must attack raising cost of medical care. Physicians are the easiest stakeholders to attack. They are the least organized.

A sneaky reduction in specialist reimbursement occurred on April 1st. Medicare eliminated consultation codes. Most specialty organizations fought hard for Medicare to recognize their physicians’ additional training and experience. Specialists are well deserving of their consultation codes and its increase in reimbursement.

Elimination of the consultation codes is a back door way of reducing specialists’ Medicare reimbursement. This sneaky reimbursement reduction is going to result in many unintended consequences. President Obama will to be very upset by the result of this action.

The AMA constructed and published a survey, along with many subspecialty organizations, about the potential effects on medical care by the elimination of the consultation codes.

The survey proves to me that physicians can get upset when they are taken advantage of once too often. I have been saying all along that the AMA has been cooperating with President Obama and his healthcare reform bill as if the AMA was President Obama’s indentured servant. I think President Obama has finally gotten under the skin of the “house of medicine” (AMA). It took a long time.

“The elimination of Medicare’s consultation codes has had a negative impact on physician efforts to improve care coordination and reduced the treatment options available to Medicare patients, according to a new survey released today by medical specialty societies and the American Medical Association (AMA).”

Physicians who see Medicare patients have taken a number of cost cutting steps to offset the losses in revenues caused by the elimination of consultation codes. The cost cutting steps have resulted in seniors experiencing limited access to medical care. They have also experienced rationing of care. Unfortunately, these unintended consequences were predictable.

Highlights from the surveyclip_image001 include:

  • Three out of every ten (30%) have already reduced their services to Medicare patients or are contemplating cost-cutting steps that will impact care.
  • One-fifth (20%) have already eliminated or reduced appointments for new Medicare patients.
  • Nearly two-fifths (39%) will defer the purchase of new equipment and/or information technology.
  • More than one-third (34%) are eliminating staff, including physicians in some cases.
  • Following CMS’s suggestions that they no longer need to provide primary care physicians with a written report, about 6% have stopped providing these reports, while nearly another one-fifth (19%) plan to stop providing them.

On December 1st when there will be a further 23% reduction in reimbursement. Seniors’ access to care will get worse. All this even before any of the major changes in President Obama’s healthcare reform act starts having its greatest effect on seniors’ care.

The Centers for Medicare and Medicaid Services (CMS) predicted, in its final physician payment rule for 2010, that no specialty would see Medicare revenues decline by more than 3%.

It turns out the minimum decline in revenue is 5%. Thirty percent of practicing specialists have experienced losses of more than 15%. This level of decrease was predictable. Most specialty practices cannot sustain cuts of this size. Specialists are reducing their services to Medicare patients.

CMS has also asserted that there is no longer any significant difference between a consultation and a routine office visit. CMS has to be kidding. Whoever believes this has no idea of the role of a consultant.

CMS has stated that consultants can send referring physicians the medical record rather than a written report. CMS recognized this dictum might discourage care coordination. Coordination of care is supposedly a priority for President Obama. CMS promised to make adjustments if there was evidence of deterioration in “effective coordination of care.”

Following CMS’s suggestion that specialists no longer need to provide primary care physicians with a written report about 6% have stopped providing these reports. Nineteen percent of specialists (19%) plan to stop providing reports and a number of others in the survey commented that they will continue providing reports but only very brief ones.

This regulation is destructive to coordinating care with the patients’ primary care physicians. The government is going in the wrong direction. There are other unintended consequences resulting from the elimination of the consultation codes. They are technical. The regulation limits payment for many services provided by the specialist.

President Obama promised the American people that he was going to reward cognitive services. Elimination of the consultation codes has the opposite effect.

One example is prolonged services for hospitalized patients. At issue is whether physicians can count time spent on any duties other than their face to face visit with the patient. Other duties include studying the patients past and present records for clues to diagnosis and treatment or discussing the case with the patient’s primary care physician or their family.

“CMS only recognizes face to face time and not other services such as establishing and reviewing charts and communicating with families and other health care professionals. In effect, Medicare is denying payment for these services and further discouraging coordination of care between professionals.”

There are other issues such as payment for a patient being seen by two specialists in one day and payment for new Medicare patients.

It is clear to me that whoever wrote these regulations has no idea of the mechanics of the practice of medicine. I doubt that anyone asked for physician inputs.

CMS is focused on changing the payment system for medical care. They are not focused on the retention of their workforce or improving the care of the American people.

President Obama believes that he will ultimately be able to force all physicians to become salaried workers of the government. I believe he will be unsuccessful.

There are many areas in the healthcare system that can be fixed to reduce the cost of medical care to affordable levels without losing the workforce.

Three important areas to improve to reduce medical costs would be effective malpractice reform, effective rules regulating the healthcare insurance industry and effective team management of chronic disease with the patient
being in the center of the healthcare team under the leadership of physicians.

All this can be accomplished by consumer driven healthcare in combination with the ideal medical savings account.

I hope President Obama is listening. Somehow, I doubt it.

The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone.

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