Medicare's decision to eliminate consultation codes has resulted in a loss of revenue for many physicians and forced some to cut back on appointments with Medicare beneficiaries, according to a survey commissioned by the American Medical Association and several other medical specialty societies.
In January, officials at the Centers for Medicare and Medicaid Services discontinued the use of inpatient and outpatient consultation codes when billing Medicare, except for telehealth codes. Physicians were asked to use new or established office visit codes, initial hospital care codes, or initial nursing facility care codes. At the time of the change, CMS officials said they could no longer justify paying physicians more for a consultation when they had reduced so much of the documentation required to bill for a consultation. The agency also said eliminating consultation codes would reduce the confusion around the differing definitions of consultations, transfers, and referrals.
But according to many specialists, the approach is flawed and is hurting both their bottom line and patient access to care.
In an online survey of about 5,500 physicians, including 639 neurologists, about 72% said that not being able to bill for consultations had decreased their total revenues by more than 5%, with about 30% reporting their revenues had fallen more than 15%.
The loss of revenue has in turn impacted physicians' practices. For example, 20% of respondents said they have already reduced the number of new Medicare patients seen in their practices. Additionally, 39% said they will hold off on purchasing new equipment or health information technology.
The policy change may also undermine efforts to improve care coordination. About 6% of responding physicians said they have stopped providing primary care physicians with written reports following consults with Medicare patients, and another 19% said they plan to do so.
Dr. Joel Kaufman, a neurologist in Providence, R.I., and vice chair of the Medical Economics and Management Committee of the American Academy of Neurology, said in an interview that the policy fails to account for the fact that consult patients are more complex than other new patients. For example, Dr. Kaufman said a new patient who self-refers to him with a headache is likely going to be a less complicated case than a patient who has already been evaluated by his or her primary care physician but still hasn't been diagnosed.
Neurologists also spend time educating the referring physician in consult cases, Dr. Kaufman said, something that is undervalued by the elimination of the codes.
In a letter to CMS, officials from more than 30 medical specialty societies, including the American Academy of Neurology Professional Association, urged the agency to revise the policy when they issue a final regulation on the 2011 fee schedule this fall.
The organizations suggested that CMS consider paying consulting physicians for providing the referring physician with a comprehensive report. They also said CMS could ease some of the financial pressure on physicians by revising its guidelines for prolonged visits to allow for reimbursement for services provided outside of the face-to-face visit.
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