Reimbursement for services

No matter where you live and practice in this wonderful country of ours, what you are able to charge for services rendered and ultimately what you make practicing health care is largely regulated by our federal government. Most, if not all, payor contracts are tied to Medicare reimbursement which means that when Medicare payments are reduced, the entire practices revenue stream (bottom line) is impacted.

The main underlying issue is that the way physicians are reimbursed is largely procedure based. A fundamental problem is that health care is a service based industry and not a business which sells widgets. It will be essentially impossible for health care to move towards a preventative based service until Medicare and other payors are willing to reimburse health care providers for their time and expertise. Doctors must be compensated for spending time getting to know their patient, taking a thorough H & P, listening to what makes that individual tick. I underscore "individual" because each patient is just that, an individual with unique needs, questions and concerns. Each patient does not fit into a nice neat pigeon hole as the payor matrix tries to suggest.

It is interesting that the few CPT codes dedicated to this process of "getting to know" the patient, and ultimately allowing the provider to make the best judgement for that individual, are all but disregarded or at least discounted. These E & M codes are the vary codes that will help to enable western medicine to move form a more "curative" focus to one of prevention. Providers must be reimbursed for their expertise in listening to a patient, gathering specific information and treating the individual as just that. Almost universally, professionals are paid for their time. As an example, Lawyers charge by the hour not by the end document or opinion produced.

Currently Medicare uses flawed formulas to determine reimbursement rates: the Sustainable Growth Rate (SGR), and Geographic Practice Cost Index (GPCI). There is currently a bill introduced in Congress by the incoming Energy and Commerce Chairman John Dingell, which would repeal the SGR and replace it with positive increases of the Medicare Economic Index (MEI) for the next two years while Congress works out a permanent solution. It is imperative that health care providers individually as well as collectively voice their concerns and opinions and not take a passive back seat hoping that these issues will be resolved. One forum for this is to post to this BLOG so that we maintain a collaborative, cohesive and coordinated voice; a working petition so to speak.

Please take a moment to contribute to this process. Respond with your thoughts, questions and ideas. I will be certain that those in power are aware of this site and listen to what is being exchanged here.