From Dr. Tom's Desk
In last week’s newsletter, I told you I felt something in the air.
All things were building toward big regulatory changes that would encourage patients to sign up for Medicare Advantage at the expense of traditional Medicare.
I put that newsletter to bed on July 11th, irretrievably sending it out for eventual publication. and then went to see a movie with my family.
And the very next day, CMS issues this press release.
Medicare is proposing making dramatic changes to the way it pays fee-for-service care in the office.
One flat fee. Minimal documentation.
No more 2/9 ROS points or “what was the nature of the presenting complaint?”
Essentially you’re going to be paid just for being in the room with a patient.
It’s an enormous, earth shattering change. The current E and M coding system is the product of 50 years of fine tuning. For almost every physician practicing today, it’s all they’ve known. And it’s gone.
Just. Like. That.
The final proposal, entered into the Federal Registry on the 27th, accurately reflects the material in the press release. There’ll be a comment period and then the proposal will be finalized sometime in early November. Don’t expect any changes.
I’ll be exploring all the implications in my ongoing series you can find here. But What do you need to know from a strictly Medicare Advantage perspective.
The pressure on primes to increase the numbers of patient visits per day will be enormous. Patients with chronic medical problems will be asked to come back repeatedly, with an individual office visit for each problem. There will be denials that this will happen. Health systems will put “safeguards” into place to ensure it doesn’t.
Don’t you believe it. Patients will experience it.
And if they have multiple chronic diseases, the marketers will let them know that, under a Medicare Advantage plan, their doctors will spend more time with them.
I’m told from stakeholders involved in the preparation for this decision that after a year of negotiations it was apparent that the parties--organized medicine, health systems, the electronic health vendors, even the coders--were never going to come to an agreement. So, CMS threw up its hands and unilaterally made the big change.
Don’t believe this either.
This is a policy with the direct intention of shifting patients into the Medicare Advantage program.
Everything points to it, from insiders jumping on boards of Medicare Advantage plans to the unprecedented favorable treatment Medicare Advantage received in the recent annual patient information publication that was sent to 30 million beneficiaries.
The wind couldn’t be any more at your back.
Are you prepared to succeed?