Pop quiz time!
Quick: When was the last time you saw your doctor?
I don’t mean the last year, month, or week … I mean the actual date of your last visit.
Don’t remember? What do you mean? Come on now! T-h-i-n-k!
Give up? Here. Let me make it simpler:
Today is 9 Feb 2009. Quick: What day was exactly 90 days ago?
Did you have to look at a calendar? Did you find this as difficult to calculate as most people do? Did you get 11 Nov 2008? No? Why not?
You see, doctors like me have to know if you were seen in the last 90 days.
Because if you had a cardiac device and IF you were not seen in the last 90 days, THEN I could bill you for my evaluation of your cardiac device with a larger paying code, ELSE I’d have to bill you with another lower-reimbursing code, BUT if your device was evaluated in the last 30 days, I couldn’t bill you at all.
Just like a computer program: welcome to the IF, THEN, ELSE, BUT loops of Medicare billing.
Isn’t this fun?
Now, multiply these IF, THEN, ELSE, BUT loops for one-lead versus multi-lead pacing systems, and one-lead or multi-lead defibrillation systems. Add a few more for evaluating sensor parameters and a few more for implantable event recorders. Then add a few more for remote evaluation versus face-to-face up evaluations. Add ‘em all together and you can have twenty-six new codes just for implantable cardiac device checks implemented 1 January 2009! Device checks whose payment is not only dependent on what you did today, but when you did the preceding evaluation, whether it's clinically appropriate or not.
It’s remarkable to me the lengths we've gone to ration health care in America without saying we’re rationing. (And it's only going to get worse.)
But folks, make no mistake: we’re rationing.
And you and your doctors are paying the price.