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June 2010
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Physicians Forced to Make Cutbacks as Medicare Eliminates Payment for Consultation Codes

Medicare’s decision to eliminate payment for consultation codes is forcing physicians to reduce services to Medicare patients, eliminate staff, and defer purchase of new equipment, according to a recent survey by the American Medical Association (AMA) and 11 medical societies, including IDSA. Few specialties have been hit as hard as infectious diseases.

When Medicare’s new policy went into effect on Jan. 1 of this year, the Centers for Medicare and Medicaid Services (CMS) predicted that no specialty would see Medicare revenues decline by more than 3 percent and that there would be little impact on the coordination of care.

But the medical societies’ survey casts serious doubts on those assumptions. Nearly three quarters (72 percent) of the approximately 5,550 physicians who completed the survey estimated that the elimination of billing for consultations had decreased their total revenues by more than 5 percent, and 30 percent experienced losses of more than 15 percent. Among ID, an extraordinary 95 percent said their total revenue stream has decreased. Infectious disease accounted for more than 10 percent of the survey responses.

The survey found that many practices cannot sustain cuts of this size and have either reduced their services to Medicare patients or are contemplating cost-saving steps that will impact care. Overall, 20 percent of all survey respondents have eliminated or reduced appointments for new Medicare patients—a concern given how common consultations are for seniors. In addition, 39 percent will defer the purchase of new equipment or information technology, and 34 percent are eliminating staff, including physicians.  More troubling for the success of the Patient Centered Medical Home and other delivery system reform ideas that are focused on reducing costs through improved care coordination, 19 percent of respondents stopped providing reports back to primary care physicians.

Among infectious disease respondents, 16 percent said they already have had to modify their practice or services. Of those ID physicians who made modifications, 60 percent said they have reduced the number of new Medicare patients, and 36 percent said they have reduced the amount of time spent with Medicare patients.  The percentage of ID physicians who stopped providing reports back to primary care physicians was even higher at 22 percent.

Nearly half (49 percent) of ID respondents said they will defer purchase of equipment or IT, and 37 percent said they will eliminate staff.

Survey results suggest that many private payers have already adopted Medicare’s non-payment policy for the consultation codes. ID practices should contact individual payers to verify.

IDSA, AMA, and more than 30 physician groups are urging CMS to revise its policy in light of the survey findings. Click here for the groups’ June 18 letter to CMS. For a summary of the survey’s ID results, click here. (You must be logged in to have access to this link.)

In response to the survey results and the letter, Medicare’s 2011 Physician Fee Schedule Proposed Rule seemed to acknowledge the challenges created by the consultations decision and requested comments on providers’ experiences with the new coding policy. IDSA members are strongly encouraged to submit comments. To submit comments, visit this website and follow the prompts for electronic submission—comments will be accepted through August 24.

Also see IDSA News, January 2010. Stay tuned to IDSA News for future updates on this issue and the proposed rule.
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