HealthLawProf Blog

Editor: Katharine Van Tassel
Concordia University School of Law

Sunday, January 29, 2012

Guest Blogger Jeff Hammond: The Doctor Will See You…Again

Here is a fascinating post from Jason Schafren, blogging as the Healthcare Economist about the ad hoc bundling that Medicare foists upon its contracted physicians and other suppliers. At least for many of the services Schafren lists, the service of the assistant, extender, derivative supplier, etc., is, in fact reimbursed, no matter how low. But, as John Goodman notes, Medicare will not reimburse primary care physicians if they want to treat co-morbidities during the same office visit. Is it any wonder, then, that physicians are now in the practice of asking patients to make separate appointments for treating those comorbidities? As Goodman states:

Medicare has strict rules about how tasks can be combined. For example, “special needs” patients typically have five or more comorbidities — a fancy way of saying that a lot of things are going wrong at once. These patients are costing Medicare about $60,000 a year and they consume a large share of Medicare’s entire budget. Ideally, when one of these patients sees a doctor, the doctor will deal with all five problems sequentially. That would economize on the patient’s time and ensure that the treatment regime for each malady is integrated and consistent with all the others.

Under Medicare’s payment system, however, a specialist can only bill Medicare the full fee for treating one of the five conditions during a single visit. If she treats the other four, she can only bill half price for those services. It’s even worse for primary care physicians. They cannot bill anything for treating the additional four conditions.

All hail inefficiency! Now, couple depressed gross reimbursement (based on number of complaints) with a base reimbursement system that is biased against primary care physicians, and you have two elements of a perfect storm brewing against primary docs and their willingness to remain in a system that seems decidedly set against them. Why do doctors, no matter how well-meaning and public-spirited, continue to put up with this financial abuse?

(H/t to Goodman’s post forthe reference to the Healthcare Economist blog.)

-Jeff Hammond

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