The end of medicine as we know it ...

[Sheherezade]

For those that are interested, there is apparently an amendment in play to stop the change. Here's an excerpt from a letter in support of the AMA action to repeal the change. I suppose we could lobby our representatives. We could just cc them this thread.

On behalf of our organizations, we are contacting you to follow-up on action by the AMA House of Delegates in passing Resolution 807, “Medicare’s Proposal to Eliminate Payments for Consultation Service Codes,” at the 2009 Interim Meeting in Houston. As you know, Resolution 807 calls on the AMA to oppose all public and private payer efforts to eliminate payments for inpatient and outpatient consultation service codes and support legislation to overturn recent CMS action to eliminate consultation codes.
Our organizations co-sponsored or actively supported Resolution 807 because we strongly oppose the elimination of payment for consultation codes. Pending the introduction of legislation to overturn this new policy, it would be extremely helpful to our organizations and the members we serve if the AMA would contact and actively work with HHS Secretary Kathleen Sebelius, CMS and Members of Congress to secure a delay in the implementation of the new consultation code policy, currently scheduled to take effect on January 1, 2010.
As you may be aware, CMS has yet to issue final guidance instructing the physician community on the appropriate use of existing CPT codes to reflect the services previously recognized through use of the consultation codes. There are several outstanding coding issues resulting from this new policy that require clarification and are not determined by a simple crosswalk from consultation codes to established and subsequent patient visit codes. We are very concerned that there will not be enough time to fully educate the practice community and the Medicare carriers on new coding policy and the result will be initial confusion, claims denials, delays in payment for services and disruptions in patient care. We believe these reasons demonstrate a strong, independent and proximate cause for delaying the implementation of this new policy.

[PrincessFiona]

For some reason, I thought this amendment was no longer active. The change has already taken effect so delay is no longer an option? Our coders have already been bouncing back codes left and right.

Is there currently a movement by the AMA to have this repealed?

Kelly, peds will be affected as well...many peds patients are medicaid....and the billing changes do not just affect consults...apparently there are a wide variety of procedures and tests now under the knife....and once private insurance makes changes to their billing structure to keep up with medicare, payment across the boards will be lowered.

Also, at least for us, system bonuses each year are paid out across the board based on system performance and not department performances. That means if cardiology, dermatology, nephrology, ID, etc don't do well and there is no longer a surplus, no one gets a bonus.

And...across the board as hospitals and research centers bring in less money, they will be able to afford less in regards to compensation.

Just feeding your rage. Clearly...I need to go clean my kitchen!!! LOL

ETA: On second thought, though I know CMS is responsible for medicare and medicaid, I'm not sure how the medicaid billing is handled with its codes in relation to medicare. Someone more knowledgeable than me will have to jump in.

[Sheherezade]

This website thinks so. (Neurology Today)

With the January 1 deadline past, Medicare is no longer accepting consult codes. However, the AAN is continuing its efforts to get an amendment passed that would delay implementation of the elimination of payment for consult codes. The AAN is working with other societies, pushing the issue on the hill, and contacting members of Congress. Neurology practices can continue billing private insurers for consultations.

[PrincessFiona]

Thus, she is not optimistic that efforts to change the CMS view on the policy will gain traction. The AMA is supporting a resolution introduced by the Infectious Disease Society of America that encourages the CMS to work with the AMA and other physician groups to address concerns with consultation codes, rather than scrap them entirely.

We need to write something on this, Angie...I think our article is taking shape! LOL

[medpedspouse]

Forget having our spouses consider going back to school for an MBA - Law... education takes too long and it is costly (graduate hour tuition).

After reading Kris' post, I think the money is in plumbing....AND after getting a recent estimate, it must also be in air conditioning. My local community college can get me out in a couple of years and the tution is pretty cheap.

[Sheherezade]

I think we should. Honestly.....it is complicated. Each specialty is different and where else is there so much conversation about these changes across so many different specialties?

I'm not arguing that these changes are not BAD; I know that they are. I think CMS just pulled the trigger. They have flirted with it for years... but now they've gone and done it. I'm also hesitant that they will repeal the move because I think it is a move they've been planning for years and years. I think they would only "repeal" it by building in a delay before it returns so that coders and hospitals can get up to speed. Other than that....it is a done deal. And I do agree - more changes will come.

That really gets me! Try saying that you are paying for extra YEARS of training, experience and that physician taking extra time?

Seriously....I can't fix the plumbing in my sink. When we had a problem a few months ago, I was sad to let the $100 go for the 10 minutes the guy spent fiddling with my drain pipe...but thank goodness the dishwasher works again and we have had no more flooding.

That's bankroll ... This guy was well compensated for his expertise. Granted, I don't need my dishwasher to live, and I get the argument which is why I support health care as a human rights issue and not a privilege...BUT...you can't load docs up with debt, beat this shit out of them in training year after year, tax them until the cows come home, demand high malpractice and sue them when your farts stink ... and then take away the financial incentive.

I think I need some lexapro today! I just said fart on a public forum. LOL

This is exactly how I feel about. Not to mention they put off buying their house till after training, save for retirement, and all the years of income they did without in order to collect debt during medical school. I agree that some doctors can be greedy at times and are drawn into medicine due to money only. Those doctors work on the incentive of making lots of money; however, if all of them quit b/c the incentive was no longer there then millions would be turned away for medical care due to the shortage of doctors.

[PrincessFiona]

I found a diff. update...dated from today...and the keep the codes website is interesting:

http://www.endocrinetoday.com/view.aspx?rid=59931

The American Association of Clinical Endocrinologists sent a petition to Congress today signed by 1,325 AACE members, non-AACE member physicians, allied health professionals and patients opposing a new Medicare policy, which would eliminate consultation codes for specialists.

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Overturning this policy would preserve access to care for Medicare patients seen by medical specialists, according to AACE.
The Centers for Medicare & Medicaid Services’ (CMS) new policy, which went into effect on Jan. 1, 2010, no longer allows endocrinologists and other cognitive specialists to bill for consultations provided for patients referred to them by primary care physicians.
“The result of CMS’ decision will be a significant reduction in the quality of care received by older Americans,” Jeffrey R. Garber, MD, AACE president and chief of endocrinology at Harvard Vanguard Medical Associates, said in a press release.
Results of an AACE survey conducted in December 2009 indicate that four out of five endocrinologists said they would be forced to drastically reduce or eliminate the number of Medicare patients seen in their practices if CMS consultation codes are eliminated.
AACE is urging Members of Congress to adopt Senate amendment 3163, introduced by Senator Arlen Specter (D-Pa.), which would delay the new CMS policy for one year to allow more time to adequately prepare for this policy change and its impact.
“AACE applauds the continued efforts of Senator Specter to delay this flawed (CMS) policy,” said Garber, also an Endocrine Today Editorial Board member.
The organization encourages medical specialists and their patients to write their Members of Congress and ask them to support the Specter amendment.
The new CMS policy will “severely restrict” patient access to specialty care and cause “major disruptions” in the health care system in the weeks ahead as new Medicare claims are processed, according to the organization.
AACE also expressed concerns about the “hasty implementation” of the policy. Guidance on how to comply with the new policy was made available to health care professionals and Medicare contractors less than two weeks before the Jan. 1, 2010 implementation date, according to the organization.
For more information about the new policy, visit the AACE or Keep the Codes websites.

[Sheherezade]

Good work. I will send an email to my congressmen. We should all do this. It is a small community -- and we don't lobby NEARLY as well as the other interest groups. Every little bit helps. Doctor's wives unite!

[Rapunzel]

OK, I'm not educated enough on this issue to write up a cohesive argument in an email to my congressperson. From what I have gleaned (thank you all ) I would very much like to have action on this immediately. Could someone send me a private message with a good email to my congressperson and senators (can I plagiarize off of one of you)?

[PrincessFiona]

Go to the website. They have a petition you can sign as well.

[DCJenn]

If it's OK with the masses, I truly think we should send this ENTIRE thread to our elected officials.

Jenn

[Pollyanna]

If it's OK with the masses, I truly think we should send this ENTIRE thread to our elected officials.

Jenn

It's okay with me!

[DCJenn]

Here's a link to the letter that the AAN sent back in August, if anyone is curious.

http://www.aan.com/globals/axon/assets/6322.pdf

[Vishenka69]

Forget having our spouses consider going back to school for an MBA - Law... education takes too long and it is costly (graduate hour tuition).

After reading Kris' post, I think the money is in plumbing....AND after getting a recent estimate, it must also be in air conditioning. My local community college can get me out in a couple of years and the tution is pretty cheap.

I totally agree. Last week the heating guy charged me $75 an hour (on top of the fee for the service call) to tinker with the thermostat.

As for the topic at hand, while DH's group isn't as drastically affected as of this moment, they are heavily subsidized by the hospital. Plus their contract is up in, I believe 2 or 3 years, at which point if this continues to snowball, they'll in all likelihood end up working for the hospital at whatever rate the said hospital dictates. So our plan for now is to sock away as much as we can and get aggressive in repaying the loans.

I'll go sign the petition online and if anyone can send me a copy of what to say to the senators/congressmen, I'll happily pass that along.