Tuesday, January 05, 2010

Poll: How Will Loss of Medicare Consult Fees Affect Your Practice?

Time to cut the denial. The ground is shifting.
Until December 31, 2009 the cardiologist could charge a “physician consult” fee for getting out of bed, coming to the hospital, and evaluating a patient with a potentially life threatening problem. Medicare paid $195.76 for this middle-of-the-night work (the same rate as when done during the day).

By eliminating the “physician consult” billing code, Medicare now advises the specialist to charge for a “hospital admission.” For two more months, Medicare will pay $175.67 for this service. However, without a change in current law, the physician’s reimbursement for a “hospital admission” will drop to $141.63 on March 1. This is why the “Doc Fix” is so important for working physicians and their Medicare patients.

Other recent and obscure changes in Medicare guidelines are potentially even worse.

As of January 1, Medicare will not pay the consultant at all unless the admitting physician uses an “HI modifier” when billing Medicare for the initial admission. This means in order to get paid, the consulting physician must rely on another physician’s billing practice. Many physicians remain unaware of this obscure change (Medicare guidelines were altered as recently as December 17). The result? Many consultants will be denied payment altogether—yet another way to “save” Medicare dollars.
For patients, the changes are already being felt. As of 1 January 2010 the lead dog, Mayo Family Clinic in Glendale Arizona, no longer accepts Medicare patients.

I'd be interested to know, how do you envision the current physician payment changes underway affecting your practice?

How Will Loss of Medicare Consult Fees Affect Your Practice? (You may select more than one)


Michael Kirsch, M.D. said...

Wes, you don't mean the same Mayo Clinic that's Obama's Holy Grail for medical practice? The ultimate goal, of course, is to beat down the private practioners so low, that an employed position (for the Mayo Clinic, perhaps?) would represent a raise. www.MDWhistleblower.blogspot.com

#1 Dinosaur said...

No change; I rarely got to bill consults anyway.

Tell me this, though: why should you get paid more when another doctor asks you to see a patient (definition of a consult) than when the patient comes on his/her own?

Anonymous said...

Each field, Hospitalist, Family doc, oncologist etc have different skills, no one can claim one is superior than the other. Though everyone agrees within each field there are great docs and not so great... how can you reward the truly great docs,very tricky isssue though deserving.

pcb said...


agree or not, but the idea is that when the "generalist" physician has a problem that they can't handle by themselves, it is assumed to be a complex congnitive scenario that needs specialist input. This higher level of cognitive service being sought should pay more, as it is presumably a more complex or difficult clinical situation that cannot be handled at the generalist level.

Anonymous said...

The reality of course is often times that the partialist is being consulted for a procedure that the generalist doesn't do. The partialist then gets paid more to copy the H&P already done(don't have to re-ask tangential grandma about her family history, social history, med list, allergies, etc as it's already on the chart), then gets paid 10xs what the generalist gets paid for the entire hospitalization to do whatever procedure it is that the generalist already knew needed to be done.

Anonymous said...

if the partialist is getting paid excessively for copying the h&p and serving as a technician for an already diagnosed problem, what is your description of the hospitalist's role?

Anonymous said...

This is Anon0417

In the case of my patients, the hospitalists role is nonexistent. But if by hospitalist, you mean the admitting doctor, their role is to admit the patient, do appropriate initial testing and treatment. In most cases no partialist will be needed. In some cases, one of them will be needed. There are several broad areas that this need breaks down into:

1)this is probably the most rare actual reason but the most popular one to cite as was done here already:(5%) I don't know what's going on or I do know what the problem is but I am unsure how to treat it

2)the patient needs some procedure that I do not do(40%)

3)it is standard of care locally to consult for this problem regardless of whether the consultant is actually going to add anything or not(25%). Chest pain consults to cardiology would be a common example of this in 2 of the 3 areas I have practiced, including residency.

4)The patient wants a consult despite my having no concerns or need to consult(20%).The percentage of the time that the consultant makes any significant change in these cases is very very small

5)This is more common in the outpatient setting but it does happen inpatient as well: while I know what the problem is and how to treat it, this patient is annoying the *$(! out of me so I'll pass them on to someone else(10%)

Now I by no means want to shortchange the importance of categories 1 and 2(and well 5 also). But it is only cat. 1 where I am truly 'consulting' And even then, most of the background data that is essentially for billing(most of the stuff listed in my prior comment) is already done

Anonymous said...

that's great for your patients. what about other patients who are seen by hospitalists? what is the description of the role they play?

what percent of patients you request consults on get procedures?
in my clinic less than 10% of the patients i see get procedures. many are either #5 or primary doc just doesn't have time to thoroughly discuss prognosis and treatment options with them (i lump those under 5 and estimate 30%).

for example atrial fibrillation. you could say the consult is for ablation, but in reality most primary doctors don't prescribe antiarrhythmics and further aren't knowledgable (meaning they haven't taken the time to educate themselves, not that they are somehow incapable) enough to recognize which patients meet current indications, how likely the procedure is to be successful, or whether they should be cardioverted first. so the consult isn't really for ablation (despite what is listed) as much for assistance in management of a very common condition. i would lump those under 1 in your system, and estimate that instead of 5%, it would be closer to 50%. just my view from the other side.

i congratulate you on being a great doctor, i think it's great for your patients.