Proposed Medicare Changes are Upsetting to Doctors and Their Patients
The Centers for Medicare and Medicaid Services (CMS) is about to roll out a new plan with the help of the Trump administration, which it says is a historic effort to reduce paperwork while improving patient care. Not everyone agrees with the Medicare changes.
The plan was published in Friday’s Federal Register and is now available for public comment. It will be open for feedback until early September. The Medicare changes would combine four levels of paperwork required for reimbursement, and four levels of payments, into one form and one flat fee for each scheduled appointment.
CMS administrator Seema Verma said that physicians waste too much patient time on administrative tasks. “We believe you should be able to focus on delivering care to patients,” Verma said, “not sitting in front of a computer screen.”
Dr. Angus Worthing, a rheumatologist in Washington, D.C., who chairs the government affairs committee for the American College of Rheumatology, tested the claim. During a typical 15- to 45-minute appointment, Worthing figures, “I might spend one to two minutes less in front of the computer, documenting and typing.”
Dr. Kate Goodrich, CMS’ chief medical officer, notes that “saving one to two minutes per patient adds up pretty quickly over time.” But Worthing says the small savings in time is not worth the reduced payment he’d get, which will be approximately a three percent decrease. And his personal net income from Medicare patients would drop by about ten percent against fixed operating costs.
“The proposal is well-intentioned, but it might cause a disaster,” he said if it leads to fewer medical students going into rheumatology and other specialties that require doctors to treat complex patients. These fields will be hit the hardest.
Al Norman, a 71-year-old Medicare patient, agrees that the plan equals disaster. “If you’re frail or if you are very healthy, you’re worth the same to a doctor [under the proposed plan], and obviously that means that the people who are more disabled or frail are less desirable patients,” says Norman, who worked on elder care issues in Massachusetts before his retirement in 2017.
Goodrich suggests that there is no incentive to see less Medicare patients. “That’s an unintended consequence we wanted to mitigate on the front end and avoid,” she said. Therefore, with the proposed Medicare changes, doctors who need more time with patients could file for an “add-on” payment of $67 per appointment. The additional payment, though minuscule, would be worth the savings in administrative time. The “add-on” is “intended to ensure that physicians are being appropriately compensated for seeing the most complex patients,” she added.
Dr. Paul Birnbaum, a Boston based dermatologist, said he’s worried that paying doctors a reduced fee per appointment will lead to shorter, rushed visits. “You would just see more people,” Birnbaum explained. “You’d move people through faster. And so, you have somebody come back for repeat office visits. And that, over time, would be inflationary” leading to more office trips and, thus, more copays for patients and higher costs for Medicare.
“There will be winners and losers and my real fear is it’s not the physicians [who will take the brunt of this]. My real fear is that it’s the Medicare beneficiaries,” said Dr. Barbara Levy, vice president for health policy at the American College of Obstetricians and Gynecologists.
“If we’re going to talk about this kind of wholesale, large-scale reconfiguration of the way reimbursement is given to doctors,” said Joe Baker, president of the Medicare Rights Center, “it’s probably best to do that in a demonstration project where we can closely study the ramifications.”
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