Primary Care Reimbursement

September 9, 2011
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Quote of the Day:
God looks at the clean hands, not the full ones.
–Publilius Syrus

A hot button topic for primary care doctors has been about the imbalance of  RVUs allotted for patient visits to a primary care doctor, and the lack of procedure codes. Unlike specialists who have a potpourri of procedures, codes, modifiers to up regulate their fees (all legal and proper), the PCPs are left with  few to chose from.

Quote of the Day:
God looks at the clean hands, not the full ones.
–Publilius Syrus

A hot button topic for primary care doctors has been about the imbalance of  RVUs allotted for patient visits to a primary care doctor, and the lack of procedure codes. Unlike specialists who have a potpourri of procedures, codes, modifiers to up regulate their fees (all legal and proper), the PCPs are left with  few to chose from.

One fear that specialists verbalize is that the ‘Medicare pie’ is only so big, and CMS is not going to increase it, so that if PCP gets more specialists will get less.

This is a strategic move on the part of CMS and HHS. It has always been this way, and that is why specialists want to continue to control the RVU process. Divide and conquer weakens our voices.

My opinion is that specialists must support their PCP referral base. If we do not then

1. Your referral base will disappear if your PCPs get wind of  your opposition

2. It is foolhardy to enjoy the fruits of medicine no matter what specialty you are in, while other MDs are suffering from disparate incomes. Any health reform must equilibrate the work/reimbursement ratios.

3. PCPs now must have at least three years of postgraduate training, unlike years ago when one year of postgraduate training made one qualified to practice general medicine

In addition to that the AMA has the copyright to CPT coding, something that every physician uses everyday. In fact that is one reason why only 165,000 licensed MDs belong to the venerable AMA.

The AAFP has begun a campaign to change the system. An article in the Wall Street Journal by Anna Wilde Matthews elaborates,

“Primary-care physicians are pressing the agency that oversees Medicare to change a payment system they say places a higher value on work done by specialists.

The American Academy of Family Physicians has sent a letter demanding changes to a committee that plays a key role in Medicare’s process for setting physician payments. The academy wants the panel to add more members representing primary-care groups, among other adjustments.

The academy also has set up a task force to propose new methods for calculating Medicare reimbursement for many of the services provided by primary-care doctors.”

In an article published in 2005 by the Dean’s Newsletter at Stanford School of Medicine, the issues about CPT codes and RVUs points out the added complexity of valuing CPT codes.

Stanford University uses a “Funds Flow Work Group” . If ACOs come to pass, this may be the model for distributing income allotted to physicians. No matter what it is going to be a very interesting and challenging time.