Trump’s overhaul of Medicare payment angers doctors

[Greenbeard]

Be careful what you wish for!

Trump’s overhaul of Medicare payment angers doctors

CMS thought a proposal to save doctors paperwork would be a public relations bonanza. Instead, most doctor groups view it as disastrous.

A provision tucked into the agency’s 1,472-page payment rule in July does away with a lot of paper-pushing, but it also appears to strip away the financial incentives to see patients with more complex conditions — upending a payment structure that has existed for two decades. The proposed rule followed months of consultation with medical groups, but many groups were caught unawares by the final product.

The uproar concerns CMS' plans to make changes in the "evaluation and management" codes, last updated in 1997. Doctors like the proposed reduction in documentation, but not the perceived tradeoff: reduced payments for time spent with difficult patients, with incentives for quick visits. CMS has tried to mitigate the problem by adding bonus payments for treating sicker patients, but the solution doesn’t go far enough, doctors’ groups and academics say.

But collapsing the codes means doctors will be paid less for treating complex patients over long periods of time, critics say, because the most intense levels of care won’t be rewarded accordingly. According to an analysis in the New England Journal of Medicine, a doctor seeing a complex patient over half an hour or more could better spend her time, financially speaking, seeing three simpler patients.