Monday, February 09, 2009

The IF, THEN, ELSE, BUT Loops of Medicare

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.



Margaret Polaneczky, MD (aka TBTAM) said...

I felt so bad for the sweet little old lady who schlepped herself into the city on 2/9/09 from upstate NY for her every 2 years breast and cervical cancer screening as paid for by medicare.

I didn't have the heart to tell her that the visit would probably not be paid because her last visit was on 2/8/07. She was one day too early.

I'll just write it off when the bill comes in....

Anonymous said...

I have put my life on hold to care for elderly, Stage 4 cancer (colon met to liver). I certainly don't want accolades. But I just have tons of time to read about what the Obama administration wants to do to the practice of medicine.

Most americans aren't getting it. The attitude has for long been "u deserve medicine like I deserve water - why shoukd I pay for it!!) Well yippee, the crazy stimulus pkg that no one read includes the introduction of "medical review board." Don't people get that people want computerized records so that a govt bureaucrat can "help" the doc at bedside with treatment decisions.

I know that my elder parents would be the first to be denied care. Daschle actually wrote in his book that old people need to accept the conditions associated with aging & stop expecting tx.

Would Kennedy & Spector get tx?

Why can't anyone in congress fess up to putting the start of socialized med into the stimulus bill? How can it "just happen"?

Where is the AARP & even AAOS and others on this issue?

My guess is that the best docs will figure out a way to opt out & work for cash only. Then other great clinicians will leave clinic & just be great researchers.

God bless the docs & the advocates for patients.