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Medicare
is doling out 1992-style payments for 2005-style evaluation
and management services, insists a coalition of 27 physician-specialty
societies and other physician organizations.
The
Centers for Medicare & Medicaid Services and the Relative
Value Unit Update Committee are approaching their scheduled
five-year review of the Medicare fee schedule.
The
27 organizations want to see Medicare drastically increase
RVUs for most E/M codes. In a Jan. 3 letter to CMS Administrator
Mark McClellan, the groups say E/M payments no longer reflect
the true cost of patient visits because:
Doctors
are expected to be more proactive in preventing diseases
as well as diagnosing and treating them. Congress has added
a number of screening tests to the Medicare benefit, including
the new "Welcome to Medicare" exam.
Doctors
have to spend more time on documentation, including jumping
through the hoops required by the 1995 and 1997 E/M documentation
guidelines.
There's
more information and more complex data for physicians to
keep track of. Again, doctors have to manage multiple drugs,
and there are more clinical guidelines to follow. Doctors
have more screening and diagnostic tests to perform and
consider in a patient's treatment regimen.
Patients
are expecting to be active partners in treating their own
diseases. They're surfing the Internet and reading newspaper
articles before visiting the doctor, and thus asking more
questions and expecting more discussions about treatment
strategies.
Patients
are expecting to communicate via e-mail and other electronic
means.
Physicians must take account of genomics, including the
concepts of genetic disease. Because scientists mapped the
human genome, physicians have had more information to consider
regarding genetic conditions. And physicians are more likely
to use genetic information when choosing treatments for
a variety of conditions.
Patients in the emergency department are more likely to
be higher acuity than before. Also, volume has increased
and so have malpractice risks.
The
letter also presents data showing that the "intensity"
of E/M services has increased. The average patient was older
and had more complex diseases in 2002 than in 1992. Patients
are leaving the hospital earlier than ever, and they're
likely to be sicker when they check out. Patients are able
to go home sooner because physicians are orchestrating their
post-hospital care.
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