Medicare's decision to eliminate consultation codes has resulted in a loss of revenue for many physicians and forced some to cut back on appointments with Medicare beneficiaries, according to a survey commissioned by the American Medical Association and several other medical specialty societies.
In January, officials at the Centers for Medicare and Medicaid Services discontinued the use of inpatient and outpatient consultation codes when billing Medicare, except for telehealth codes. Physicians instead were asked to use new or established office visit codes, initial hospital care codes, or initial nursing facility care codes. At the time of the policy change, CMS officials said they could no longer justify paying physicians more for a consultation when they had reduced so much of the documentation required to bill for a consultation. The agency also said that eliminating consultation codes would reduce the confusion around the differing definitions of consultations, transfers, and referrals.
But according to many specialists, the approach is flawed and is hurting their bottom line and patient access to care.
In an online survey of about 5,500 physicians, about 72% said that not being able to bill for consultations had decreased their total revenues by more than 5%, with about 30% reporting their revenues had fallen more than 15%.
The loss of revenue has in turn affected physicians' practices. For example, 20% of respondents said they have already reduced the number of new Medicare patients seen in their practices. Additionally, 39% said they would hold off on buying new equipment or health information technology.
The policy change also might undermine efforts to improve care coordination. About 6% of responding physicians said they have stopped providing primary care physicians with written reports following consults with Medicare patients, and another 19% said they plan to do so.
The elimination of consultation codes “will create a real hardship for Medicare patients, many of whom have chronic medical conditions that can be exacerbated when their psychiatric issues are not treated,” Dr. James H. Scully Jr., medical director and CEO of the American Psychiatric Association, said in a statement.
“Coordination of care between physicians is vital to maintaining the health of our Medicare population. In a letter to CMS officials, more than 30 medical specialty societies including the AMA and the APA, urged the agency to revise the policy when they issue a final regulation on the 2011 Medicare Physician Fee Schedule this fall.
The organizations suggested that CMS consider paying consulting physicians for providing the referring physician with a comprehensive report.