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Consultation Codes: Medicare Sends A Message To Specialists

A study published in this week’s Archives of Internal Medicine looked at so-called errors made in consultation code billing by specialists seeing patients at the request of a primary care practice in suburban Chicago. The methodology? Comparing the primary care office referral form with the specialist’s bill.
The author concludes that specialists are greatly overusing consultation codes in situations where a new patient visit would be more appropriate, to the tune of over half a billion dollars a year in Medicare payments, and suggests that it is time to reconsider the use of these codes. (Medicare, of course, has already come to the same conclusion, and beginning January 1 of this year, is no longer paying for consultation codes.)

There may be misuse of consultation codes going on, but this study does not necessarily prove that. The methodology does not include medical record review, the standard by which coding choices are verified or refuted, and relies entirely on the referring physician’s determination of what the specialist should be billing. Read more »

*This blog post was originally published at The Blog that Ate Manhattan*

Medicare Is Bankrupting Doctors And Hospitals

Elderly People Street Sign by Ethan Prater via FlickrMedicare, the government insurance company for everyone over age 65 (and for the disabled), pays fees to primary care physicians that guarantee bankruptcy. Additionally, 70% of hospitals in the United States lose money on Medicare patients. That’s right … for every patient over age 65, it costs the hospital more to deliver care than the government reimburses. That is why Mayo Clinic has said it will not accept Medicare payments for primary care physician visits at its Arizona facility. Mayo gets it. Nationwide, physicians are paid 20% less from Medicare than from private payers. If you are not paid a sustainable amount, you can’t make it up in volume. It just doesn’t pencil out. Read more »

*This blog post was originally published at ACP Internist*

Physician Pay For Performance: My 2008 Experience

It’s official. Happy has now earned his CMS physician  pay for performance PQRI Bonus for 2008, a direct deposit into Happy’s bank account. PQRI stands for Physician Quality Reporting Initiative.  How much was my PQRI Medicare pay for performance bonus for calendar year 2008? A $2,500 check written out directly to Happy by the  Medicare National Bank.  CMS gives a wonderful overview of the history of PQRI .  PQRI is the Medicare pay for performance program for physicians that was initiated by Congressional mandate in the latter half of 2007.   Doctors have an opportunity to earn back 2% of their gross Medicare collections (which the government calls a bonus but which I call legalized theft) by submitting a grotesque amount of quality performance paper work to the Medicare National Bank. It’s one giant PQRI guideline game.

PQRI reporting is currently voluntary, but legislation in future years will certainly mandate reductions in payment for not submitting data, all but making this program a punitive standard.  Many physicians failed to meet the requirements to get paid under CMS pay for performance program guidelines in the latter half of 2007, the first year for PQRI measures. Read more »

*This blog post was originally published at The Happy Hospitalist Blog*

Academic Medical Centers and the Poor: Dartmouth Data Revisited

In a recent Health Affairs blog, Wennberg and Brownlee lamented that op-eds, blogs, letters to members of Congress, broadsides in the press and now a report from the American Hospital Association decry the Dartmouth Atlas as a lot of “malarkey.” Once again they tried to defend their work by proving that race and poverty don’t matter, but they do. Even the “impartial” introduction by the editor of Health Affairs, a member of Dartmouth’s Board, couldn’t save the day: “Wennberg and Brownlee rebut claims that variations among academic medical centers are due to differences in patient income, race, and health status.” Wrong, again! That’s exactly what variations are due to. Read more »

*This blog post was originally published at PHYSICIANS and HEALTH CARE REFORM Commentaries and Controversies*

Illegible Signatures Now Considered Fraud

Reporting-Medicare-FraudHow widespread is Medicare fraud?  The government is now reporting Medicare fraud rates almost three times higher than previously accounted for, at 47 billion dollars this year.  How could Medicare Fraud triple in a year?  The answer is simple.

In an effort to be more honest with data collecting, Obama ordered the new accounting into effect.  All part of the hope and change we always hear about.

It’s not clear whether Medicare fraud is actually worsening. Much of the increase in the last year is attributed to a change in the Health and Human Services Department’s methodology that imposes stricter documentation requirements and includes more improper payments — part of a data-collection effort being ordered government-wide by President Barack Obama next week to promote “honest budgeting” and accurate statistics.

Read more »

*This blog post was originally published at The Happy Hospitalist*

Latest Interviews

IDEA Labs: Medical Students Take The Lead In Healthcare Innovation

It’s no secret that doctors are disappointed with the way that the U.S. healthcare system is evolving. Most feel helpless about improving their work conditions or solving technical problems in patient care. Fortunately one young medical student was undeterred by the mountain of disappointment carried by his senior clinician mentors…

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How To Be A Successful Patient: Young Doctors Offer Some Advice

I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…

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Latest Book Reviews

Book Review: Is Empathy Learned By Faking It Till It’s Real?

I m often asked to do book reviews on my blog and I rarely agree to them. This is because it takes me a long time to read a book and then if I don t enjoy it I figure the author would rather me remain silent than publish my…

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The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

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Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

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