Doctors hate Medicare's proposed billing changes
Source: Axios
Physicians have inundated the Centers for Medicare & Medicaid Services with comments in a bid to kill a major change to how they would get paid for routine patient visits.
Where it stands: Medicare wants to create a new, fixed payment rate next year for all office visits, regardless of how much time physicians spend with the patient or how sick the patient is.
For most new patients, doctors would get paid $135 for an office visit (compared with the current range of $76-$211, depending on the visits medical code).
For returning patients, doctors would get paid $93 (compared with the current range of $45-$148).
Some codes could be added to account for complex visits.
What they're saying: Pretty much every state and national physician group (including the American Medical Association) hates the proposal and wants it dead. Doctors who would lose the most money, such as oncologists and neurologists, were the most vocal.
Read more: https://www.axios.com/doctors-hate-medicare-proposal-fixed-payment-office-visits-b526e5ff-9a8d-448c-b995-626657622d40.html
Most people do not realize that most Medicare patients are on a fixed income, like myself, I have to pay 20% of that fee, unless I have some supplemental plan..................I think in my opinion it should be paid 100% with no out of pocket expense..............medical cost do not keep up with inflation costs..................or drug prices...................
NJCher
(35,428 posts)This unpopular proposal will only increase that number.
turbinetree
(24,632 posts)on this "Dashboard" for drug costs for example: on what the monthly costs are for some of the drugs and what the drug companies are going to charge, they may add a molecule to the drug or take out one, just to justify the price increase:
In 2012, Medicare spent 17 percent of its total budget, or $109 billion, on prescription drugs. Four years later in 2016, spending had increased to 23 percent, or $174 billion. In 2016, the drugs listed below accounted for $39 billion in total spending by Medicare and Medicaid.
Medicare Part B
Brand Name
Generic Name
Annual Growth Rate (2012-2016)
Average Monthly Spending Per Beneficiary in 2016
Manufacturers
1
Orencia*
Abatacept*
17.2%
($22 to $41)
$2,136
BMS Primarycare
2
Neulasta
Pegfilgrastim
8.5%
($2,788 to $3,869)
$1,195
Amgen
3
Xolair
Omalizumab
8.0%
($22 to $30)
$1,821
Genentech, Inc.
4
Vaccine Influenza Injection Muscle (Fluzone High-Dose)**
6.9%
($30 to $39)
N/A
5
Sandostatin Lar*
Octreotide Acetate, mi-Spheres*
6.8%
($123 to $160)
$3,202
Novartis
6
Prevnar 13
Pneumococcal 13-Valent Vaccine
6.1%
($132 to $167)
N/A
Wyeth Pharm
7
Remicade
Infliximab
6.0%
($63 to $80)
$1,910
Janssen Biotech
8
Rituxan
Rituximab
5.6%
($615 to $765)
$1,985
Genentech, Inc.
*Indicates multiple brand and/or generic names for a specific HCPCS code.
**Indicates brand/generic names unavailable. Name reflects the HCPCS short description.
Medicare Part D
Brand Name
Generic Name
Annual Growth Rate (2012-2016)
Average Monthly Spending Per Beneficiary in 2016
Manufacturers
1
Renvela
Sevelamer Carbonate
21.6%
($3 to $6)
$630
Genzyme
2
Lantus
Insulin Glargine, Hum.Rec.Anlog
18.6%
($13 to $25)
$209
Sanofi-Aventis
3
Zetia
Ezetimibe
18.3%
($5 to $9)
$181
Merck Sharp & D
4
Enbrel
Etanercept
18.2%
($498 to $972)
$2,741
Amgen
5
Humira Pen
Adalimumab
18.0%
($1,019 to $1,976)
$2,835
Abbvie US LLC
6
Lyrica
Pregabalin
17.4%
($3 to $6)
$205
Pfizer US Pharm
7
Lantus Solostar
Insulin Glargine, Hum.Rec.Anlog
14.2%
($14 to $25)
$196
Sanofi-Aventis
8
Crestor
Rosuvastatin Calcium
13.2%
($5 to $8)
$124
Astrazeneca
9
Januvia
Sitagliptin Phosphate
12.7%
($7 to $12)
$235
Merck Sharp & D
10
Xarelto
Rivaroxaban
10.6%
($8 to $12)
$202
Janssen Pharm.
11
Eliquis
Apixaban
10.4%
($4 to $6)
$194
BMS Primarycare
Medicaid
Brand Name
Generic Name
Annual Growth Rate (2012-2016)
Manufacturers
1
Lantus
Insulin Glargine, Hum.Rec.Anlog
18.7%
($13 to $25)
Sanofi-Aventis
2
Latuda
Lurasidone HCl
18.6%
($17 to $33)
Sunovion Pharma
3
Lyrica
Pregabalin
17.9%
($3 to $6)
Pfizer US Pharm
4
Enbrel
Etanercept
17.6%
($487 to $933)
Amgen
5
Humira Pen
Adalimumab
17.5%
($1,007 to $1,919)
Abbvie US LLC
6
Lantus Solostar
Insulin Glargine, Hum.Rec.Anlog
14.3%
($15 to $25)
Sanofi-Aventis
7
Abilify
Aripiprazole
11.4%
($21 to $32)
Otsuka America
8
Vyvanse
Lisdexamfetamine Dimesylate
11.0%
($5 to $8)
Shire US Inc.
https://www.cms.gov/newsroom/press-releases/cms-unveils-enhanced-drug-dashboards-increase-transparency-drug-prices
pnwmom
(108,925 posts)sakabatou
(42,083 posts)I think Stanford hospital is one of them.
Perseus
(4,341 posts)Accepting Medicare and Medicaid should become mandatory.
The Medical industry has become so greedy, but the worst part is they want more money for the lesser quality that they provide to patients. Most doctors spend five to ten minutes with their patients while the nurse does all the work.
Greedy profession.
sakabatou
(42,083 posts)LisaM
(27,762 posts)You'd think that if they could ax some of the paperwork, doctors would approve of this - and it also seems as if they could make it even out by spending less time with people who don't need it, and more with people who do?
This article is a little lean on specifics.
turbinetree
(24,632 posts)LisaM
(27,762 posts)It makes doctors out to be nothing more than greedy money grubbers, so there has to be more to it.
Hoyt
(54,770 posts)etc., codes. In fact, it gets a lot of docs in trouble when they code the highest paying codes (over and over) and get audited because they likely should have been billing the lower paying codes.
It looks to me that this is a pretty good proposal. Sad fact is, a lot of docs think they should be paid for seeing a patient for 5 minutes, as if they were seeing a complicated patient that typically takes 40 minutes or so.
turbinetree
(24,632 posts)If everyone where to think that way.....................hold on, the 8 hour work day requirements would have to be revamped quickly, even for job interview.....................Go for a job interview and you have to get paid by the company for the interview................walk into a doctors office it is automatic fee, and if you don't cancel on time you pay..............
pnwmom
(108,925 posts)that some patients have much more complicated cases and require more time than others.
Many doctors ALREADY only spend a few minutes per patient.
dbackjon
(6,578 posts)And seeing THREE patients in the time allotted for one.
pnwmom
(108,925 posts)McCamy Taylor
(19,240 posts)Doctors will cherry pick healthy seniors. Those who have severe health issues will be out of luck. Unfortunately, this is a game that all insurers play. Encourage doctors to set up their practice in affluent areas, away from bus lines, away from minorities. If there are no doctors in the parts of town where the sickest people live, then the sick people will not see the doctor as often. In this, Medicare is acting just like Blue Cross and all the others. It is trying to please the elderly who are healthy/rich/have the most political clout by making it easier for them to see a doctor for their toenail fungus or allergies, while denying care to the neediest who have end stage renal disease, heart failure, emphysema and cancer.
Marrah_Goodman
(1,586 posts)I am on SSDI and live on a very limited budget. I pulled a muscle in my leg badly. I can barely walk. No pain meds because of addicts so they just sent me to physical therapy. After the appt I found out I have a 30 dollar a visit copay. I had to tell them to cancel all future appts and used the last of my money for the month to pay them. It's very frustrating and embarrassing and I left in tears.
Ohiogal
(31,669 posts)They should tell you up front about any co pays for ANYTHING. How embarrassing to have to cancel all the rest of your appts. $30 per visit, that's not exactly pocket change. What in the world is wrong with our society that so many cannot afford basic medical care?
Vinca
(50,170 posts)There is nowhere to find out what something costs before you have it done and the charges vary from facility to facility. It's very frustrating.
arithia
(455 posts)I *could* purchase supplemental coverage that would mostly cover the prescriptions I need, but that money represents my power bill and I'd still have to pay copays/deductibles so... yeah. Chose to not treat my degenerative condition so I wouldn't have to be homeless.
That shouldn't be a thing, but it is. And to think, we GOT SSDI. For most qualified applicants it takes years if it ever happens. We are the LUCKY ones.
'Murica, right? *facepalm*
eyeofnewt
(146 posts)Hi: infrequent poster here but this really hit home. I was told I needed PT for my knee to delay being disabled within 1-2 yrs, according to the ortho dr. I have private insurance through my job and each visit is a $30 copay! My first visit was to be next week and thats cancelled. Theres no way I can afford that. Better yet, I can just see my medical record reflecting my non-compliance with recommendations 😡
Jopin Klobe
(779 posts)... it appears that the Capitalist Doctors are finding out that the Capitalist oligarchs that own the Capitalist politicians ...
... want the Doctors to turn into Soviet-styled Communists ...
... "The same pay regardless of the work required." ...
... either that, or they just want to turn the current money-churning, medical abattoirs into mechanic shops using flat-rate repair books ...
EarthFirst
(2,877 posts)DeminPennswoods
(15,246 posts)shows the rates to be about the average of each range. For new patients, a little below the avg (287/2=144) and returning patients, a little above (193/2=97).
pnwmom
(108,925 posts)or very sick people because they know that this will only take away from the care of their other patients.
RVN VET71
(2,686 posts)And it's not just Republicans.
Medicare is struggling? Hey, I got a brilliant idea! Just tell the doctors we're going to pay them less.
How many physicians who can opt out of the program, under those circumstances, will opt out, leaving behind, tragically, millions of people who depend on Medicare but cannot find a competent physician.
Medicare tax is currently 1.45% of income. It needs to be dramatically raised, for starters -- maybe as high as Social Security's 6.2% -- which also ought to be raised, again "for starters," to help make THAT system solvent.
dlk
(11,438 posts)This is by design.
Tribalceltic
(1,000 posts)3 patients in a 15 minute block
12 per hour
X $93.00
= $1116.00 per hour
X 8 hours
= 8928 per day
Even if they take the whole 15 minutes with each patient
4 per hour X93 =372 per hour =2976 per day
Lining up patients like cattle.. waiting in the exam room as well as the waiting room.
CountAllVotes
(20,854 posts)Where?
All I can get with a pricey supplemental plan that pays the difference is a ... NURSE!
McCamy Taylor
(19,240 posts)for docs in private practice. So that is $1500 a day if the doctor is seeing sick people who take up the whole 15 minutes. That makes about $7500 a week gross, or $350,000 annual. Assuming no one misses an appointment. Now take away from that gross vacation time, maternity leave time, sick time, malpractice insurance, the family's medical insurance, disability insurance, money invested for retirement--because docs in private practice have no benefits. If the doc is a new graduate, be sure to factor in the greater than $500,000 education debt. And if the patients need a full half hour (like many of my sickest patients need), then the doctor has to pay all that stuff out of $175,000 gross. Ouch.
No one is getting rich on Medicare. Getting by maybe.
But you are correct. The profits rise fast if the doctor sees only healthy seniors for 5 minutes each. So set up your practice near the country club, away from bus lines and offer botox and testosterone injections. You will do quite well.
dhol82
(9,351 posts)I am a retired medical professional. I know how much running an office can cost.
The reimbursements are pathetic. The only way they can be adequate is if you are in a large office and run a large number of visits.
These proposals just want more physicians to opt out of the Medicare system.
My bigger unhappiness is with the 20% that Medicare doesnt cover. I have purchased a plan for that that costs more than triple for what I pay for the basic costs. That is egregious! Why should the private portion be so unethically larger?
Just my two cents.
MichMan
(11,790 posts)I am a few years away from retirement and have been paying into Medicare since I was 16.
Also, If like you say the current reimbursements are artificially low, can medical practices stay viable under Medicare for All with every patient paying those same reimbursements ?
keithbvadu2
(36,369 posts)These laws and rates should apply to Congressional health plans as well.
YOHABLO
(7,358 posts)Sgent
(5,857 posts)is how Medicare undervalues cognitive work. A neurologist could spend 40 minutes with you taking a history and doing an exam, and get paid X. A dermatologist could spend 10 minutes with you and get paid 3X.
Medicare overpays procedures and underpays cognitive services, and its been that way for a long time.