Part B Insider (Multispecialty) Coding Alert

Published on Wed Apr 11, 2007 PDF

Change is in the air for physicians billing Medicare

Warning: Drastic moves to slash at the growth of physician spending could be on the way. A March 10 hearing of the House Ways & Means Health Subcommittee considered some fixes, including:

- Putting one physician on the spot for all the care each patient needs for a particular -episode- of care. It would be easy to group most physician services into individual -episodes- and then give the responsible physician a -score,- claimed Glenn Hackbarth, chair of the Medicare Payment Advisory Commission (MedPAC).

Hospitals and other providers already receive Medicare payments based on -episodes,- and this keeps spending under control, claimed Robert Berenson, a senior fellow with the Urban Institute.

Physician groups, including the American Academy of Family Physicians and the American College of Physicians, encouraged Congress to try the -patient-centered medical home.- This way, your doctor could receive a monthly fee for managing your patients- long-term illnesses, and in return your doctor would have to coordinate all of the patients- care.

- Bundling more services into procedures, the way pre-op and post-op visits are bundled now. The only drawback would be that doctors could refer their patients to other doctors for the bundled services, Hackbarth said.

- Giving doctors a report card to let them know how many services they-re providing per patient, compared to other local doctors in the specialty. -Many physicians are highly motivated individuals who strive for excellence and peer approval,- said Hackbarth. Physicians who were identified as money-wasters -may respond by reducing the intensity of their practice.-

- Imposing standards for imaging services, and maybe also for other physician services.

- Fixing distorted prices for services like imaging scans, which get cheaper the more of them your practice does, Berenson said. Medicare payments for physician services have gone up more than 9 percent a year since 2000, Hackbarth noted.

In other news:

- New York City is offering 1,000 discounted electronic medical records (EMRs) to physicians who have at least 30 percent of their patients enrolled in Medicaid and other state-funded programs, the American Medical Association reported.

- Most patients haven't heard anything about EMRs, and they believe their doctors use paper records only. However, patients would be more likely to visit a doctor who used EMRs, according to a survey of 1,000 adults by Kaiser Permanente. And over two-thirds of adults agreed that the benefits of EMRs outweighed any privacy risks.