CMS Proposed Fee Schedule 2019 BAD NEWS?

[Dobbyrocks]

Has anyone seen this?

https://www.policymed.com/2018/07/cms-proposed-evaluation-and-management-e-m-documentation-and-payment-changes-are-sparking-backlash-and-may-hurt-patients.html

Under the scenario envisioned for Table 22, rheumatologists would be in for a 3% cut. Allergy/immunology and hematology/oncology practices, along with neurologists, would receive a more minor, less than 3% estimated decrease in overall payment. Nurse practitioners might see a 3% bump, while psychiatrists and physician assistants are among the group that might get a less than 3% increase in overall payment.

 

Nurse practitioners get a bump while we get a cut? What the heck?

[LAWPA]

3 hours ago, Dobbyrocks said:

Nurse practitioners might see a 3% bump, while psychiatrists and physician assistants are among the group that might get a less than 3% increase in overall payment.

Nurse practitioners get a bump while we get a cut? What the heck?

I think you misread. That says PAs and psychiatrists will receive an increase, but it may not reach 3%. And it nearly says that same about NPs; that they would receive an increase, that may reach 3%.

[PACJD]

Yes definitely misread... if anything this is a GOOD THING. We could be getting a 2.9% increase while NPs get a 3.0% increase... This article is more concerning for the specialist physicians who could be getting the cuts.

[ventana]

since we are paid off the physician schedule, this makes no sense....

 

[mgriffiths]

"In terms of specifics, CMS proposes single blended payment rates for new and established patients for office/outpatient E/M level 2 through 5 visits and a series of add-on codes to reflect resources that are needed beyond which is accounted for in the single payment rates."

- whether anything else makes sense...this is the part that makes no sense to me.  I see a walk-in for post-nasal drip or some viral cold and that bills the same as an uncontrolled DMII with HTN, claudication, diabetic foot ulcer, etc., etc., etc., etc.!!!!  That is just plain stupid.  I had heard something about it but brushed it off as too stupid to be reality...guess I was wrong.  I'll have to brush up on those "add-on codes."

[LAWPA]

13 hours ago, mgriffiths said:

- whether anything else makes sense...this is the part that makes no sense to me.  I see a walk-in for post-nasal drip or some viral cold and that bills the same as an uncontrolled DMII with HTN, claudication, diabetic foot ulcer, etc., etc., etc., etc.!!!!  That is just plain stupid.  I had heard something about it but brushed it off as too stupid to be reality...guess I was wrong.  I'll have to brush up on those "add-on codes."

The idea is that you would probably code that post-nasal drip/etc as a level 2, whereas the "all you can diagnose buffet" patients are going to be level 4, possibly a level 5. And yeah, the 'modifier codes' are incredibly tedious.

It's still a silly system, as there aren't exactly "rules":

[mgriffiths]

41 minutes ago, LAWPA said:

The idea is that you would probably code that post-nasal drip/etc as a level 2, whereas the "all you can diagnose buffet" patients are going to be level 4, possibly a level 5. And yeah, the 'modifier codes' are incredibly tedious.

That is how it works now.  The more complex patient is 99214-99215 based on a variety of factors, but the new proposal is that everything (99212-99215) is all reimbursed at the same RVU rate = 1.22, rather than a 99212 = 0.49 RVUs; 99213 = 0.97 RVU; 99214 =  1.5 RVU; and 99215 = 2.11.  In other words - if someone averages > 1.23 RVUs per patient they will be taking a pay cut, while those who bill at < 1.22 per patient will receive a raise.

Basically, it pushes all providers to do less at each visit and see more patients per day.  What incentive do I have to take care of 2+ complex issues in one visit, when if I only take care of 1 and have the patient return another visit I am able to generate more RVUs?  The only reason to do this is to ignore billing and just focus on patient care...but that only works for so long as we have to profitable to be able to exist and help anyone.