2013 Brings a 25% pay cut for doctors

Medical Phone2013 Brings a 25% pay cut for doctors

Do you know how much Medicare pays your doctor on your behalf?

How will the 25% Doctor Pay cut affect care for the Frailest Seniors including those living in an Assisted Living Institutions or Assisted Senior Care Settings?

How do you think the 25% pay cut doctors are getting will affect care in Senior Living Settings like Assisted Living, Residential Care Homes, Home Care, or Hospice Care?

New Medicare fee schedule for 2013

99215 complex office visit, Medicare fee scheduled amount, for participating doctors 2012 $144.67 2013 $108.43

Blood Pressure and Stesthescope

How do you think Doctors Feel?  Questions to ask yourself.

Do you think doctors will be thinking about doing more, providing more continuity of care, building stronger relationships, take extra time to listen and assist in navigating the increasingly complex health care system or might they react differently?

How have doctors reacted for the last Decade?  I have observed they have quit  private patient centered practice and taken jobs as institutional, or hospital controlled employees.  Is that what you observed?

Do you think Assisted Living, and any care home will have an easier time getting medications, refills, follow up for you, and the patients they offer protective supervision for?

Did you know that all doctors get paid exactly same for a 99215 or complex office visit?  That is right, if they spend one hour, or two hours and if they make lots of extra phone calls, if they answer the phone at night for you, they get the exact same pay from Medicare as the clinic doctor you do not know, have little hope of ever seeing again, and who might have not investigated your full story as completely as someone who you have an longer term relationship with.

Health Care is more of a unknown "Service" or "Product" than other services or products. 

Did you know that based on the Medicare CPT Code payment system all doctors are “the same”?  The CPT code system pays all doctors exactly the same for a 99215 no matter what they do, or how much extra they do.

The terms of “% “are very misleading.  For Example, Medicaid  as primary coverage (Not Medicare) pays 100% of a doctor visit,  but they only pay 10 dollars for that doctor visit.  100% of $10 = $10.   For advertising purposes 100% sounds much better.  Likewise, what a doctor is doing, or could do, are largely unknown to most.  How many feel confident they know what one doctor does compared to another doctor and how that is cost effective for their private pay dollars?  Indeed, patients and now many doctors may have widely varied descriptions of what they could do and why it is cost effective for a senior and their family to spend private funds on that.

25% pay cut or new price for complex visit and all follow up until the next visit – $108 dollars.

What is a CPT code?  See link to a cms Medicare Description of a complex office visit code.


Relative Value of a Doctor’s Visit vs. Women’s Hair Stylist Visit, and DVD or Blue Ray Player purchased from Best Buy.

Doctors 99215 office visit.  One might ask what does a visit mean?  The following are just a few very general, things you may not think that are part of providing this service to you.

Keeping/storing your records for a  5-7 year period and being responsible to retrieve them in a timely manor.

Once they are “your Patient” even for one visit, the doctor is responsible to answer phone calls from patients, families,  Assisted Living, Residential Care Homes, Nursing Homes, and other care settings regarding their care including refill of medications.  Recall, the doctor only gets his 108 dollars if you visit him,  if you do not visit him and he refills medications on the phone then that is “included” in the 108 dollar visit he got on the last visit.

Do you know that it is not required for Doctors to have Malpractice insurance and that 20-30% of out patient doctors may not have it?   How does that affect you or the care they are providing to you?

How much does a women’s haircut

and style cost?  $50 -100.  What type of risks and long term commitment does she assume with her one hair cut visit?
Does she keep records?
What are the overhead costs to a Hair Stylist visit and how do those compare to to the overhead costs of a Doctor’s visit?
DVD Player at Best BuyHow much do you pay for a DVD Player at Best Buy?  50-100?  How much service do you really expect if it breaks?  What type of customer service do you practically expect to get when it breaks or does not work?  A basic policy of bring it back within 30 days and we will refund your money and that is it?

How do you determine what services, amount of personal attention is important to you?  Questions you might ask.

What “assistance” do you get from any care setting?  What is “Assistance”? Does it include medically related care?  Does the management have any medical care experience; do they “need” any medical care experience?  What do you need and want and how do you define Assistance, Assisted Living, and Assisted Senior Living?
The examples above are intended to show us that health care is a service, and like all services it depends highly on the individual people providing it.  We need to meet all of the people involved: management, owner, administrator, caregivers, medication technicians, and doctors if there is a house doctor to know what we are getting.  While we will still may not know it all,  by meeting the individuals in the team, we are much better able to decide on the value for our private care dollars.

Impact on Senior Care and All Senior Care Settings.

How does all of this affect Senior Care, and most importantly,  Care for seniors who are really sick, have multiple chronic diseases, and are likely to need assistance.  This will further reduce continuity of care by further pushing doctors out of medicine.  Some doctors who are unable to do anything else will just accept the new roll as a salaried employee/ doctor or the institution.  We believe that all people who get a salary will start to behave more like employees than old fashioned doctors.  The respected role of “Doctor” is changing and it is up to both doctors and patients to reevaluate what type of care they want and in what type of care setting they get it.
Do residents and families choose a Big, Institutions with hundreds of residents or do they choose smaller care settings where you know the owner, administrator, staff and they all know you are another choice.  Finally, do not under estimate knowing and working with one doctor  when you are older, and  have many care needs and health concerns.   Continuity of the Care is the care.  In all cases, the care team including the doctor,  in each setting big or small, will determine the value you are getting for this very expensive item of Senior Care.  Senior care costs more than a new car every year and is a product most do not know as well as a car.

Is this the fix?  Is it fixed? or do we need to value people, doctors, and continuity of care?
Then this news Alert,

Medscape Medical News

Fiscal-Cliff Deal ‘In Sight,’ Said to Include 1-Year Doc Fix

They may be pushing the Medicare cut back one year.  Now Doctors can just expect that cut next year.  They have one more year to plan their escape from Medicare.  Or Doctors, Patients, and Society can embrace Continuity of Care especially for the frail Elderly and those living in an Assisted Care Setting.
One must wonder how these constant changes and proposed "fixes" to the payment system without addressing the care system are suppose to help care and caring?  It is unclear that any one has changed their relative value for Continuity of Care which we believe is essential to get and provide High Quality Care.    But only time will tell if it helps continuity of care and care or not.
Health Care is about Continuity of Care and relationships.  Be cautious not to apply the six sigma standard of assessing business efficiency, and quality control when looking for health care services.
By Shawn McGivney MD, RFA

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