OPINION
DOCTORS' Lounge
is that we will grow complacent or succumb
to the denial that is present in all human
beings and fail to catch something early. As
long-established patients who have mostly
been well get older and older, they are more
likely to have something new go wrong,
and a certain degree of interrogation truly
is required. Familiarity can breed mistakes.
What is disturbing in the description
of the new fee schedule is that it says we
can base the level of care on “medical de-
cision-making” or on “time spent,” but the
“blended payment” for both simple and
complex visits is the exact same amount. I
interpret this as, “whichever way we think
it is easiest for us to type it” will work. They
interpret this as, “You all can write it down
any old way, but we won’t pay you for it.
Take a pay cut.”
Clearly this does not value the cognitive
services required for various levels of illness
and frailty. There will be “codes that we can
add on” to address this problem, which may
be buried in the 1,400-page document that
I have not yet read in full. Nominally they
are to be used to add fairness back into the
fee schedule. The ACP has not commented
on these codes in any financial detail, just
that they exist.
The ACP is all excited about the new
codes for virtual e-visits, and now there are
codes for interpretation of elsewhere tests
done with virtual visits. Some of the ridic-
ulously detailed documentation for durable
medical equipment and outpatient therapy
services has been streamlined. Two people
in the same office can now see you on the
same day for separate things (as is diabetic
teaching and then MD visit), and both visits
will now count separately.
But by and large, unless this extra
code-using is a just and fair amount, pri-
mary care doctors, APRNs and specialty
doctors who mainly think, instead of doing
things to you involving needles and knives,
will take a loss. I think, after a couple years
GLMS MAKES
House Calls
WE KNOW YOU ARE BUSY SO LET US
COME TO YOU!
of the current fee schedule, they have finally
figured out just how valuable we are. They
have said to themselves, “We can’t afford
you. But we have to afford chemo and sur-
geries and rehab, so down you go.”
Just wait until CMS is paying the spe-
cialist fees for everything, since the office
doctors of the future will be APRNs who
will hit the diagnostic wall sooner and turn
for help to subspecialists (we just hope there
will be rheumatologists and neurologists
left, since they too are “thinking” doctors).
Maybe the final regulations will prove
me wrong. We can only hope.
Dr. Barry practices Internal Medicine with
Norton Community Medical Associates-Bar-
ret. She is a clinical associate professor at the
University of Louisville School of Medicine,
Department of Medicine.
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SEPTEMBER 2018
37