Loss of Consult Codes Reducing Medicare Access

BY MARY ELLEN SCHNEIDER
Elsevier Global Medical News

Medicare’s decision to eliminate consultation codes has resulted in a loss of revenue for many physicians and forced some to cut back on appointments with Medicare beneficiaries, according to a survey commissioned by the American Medical Association and several other medical specialty societies.

In January, officials at the Centers for Medicare and Medicaid Services discontinued the use of inpatient and outpatient consultation codes when billing Medicare, except for telehealth codes. Physicians instead were asked to use new or established office visit codes, initial hospital care codes, or initial nursing facility care codes. At the time of the policy change, CMS officials said they could no longer justify paying physicians more for a consultation when they had reduced so much of the documentation required to bill for these consultations. The agency also said that eliminating consultation codes would reduce the confusion around the definitions of consultations, transfers, and referrals.

However, many specialists believe that the approach is flawed and is hurting both their financial bottom line and patient access to care.

In an online survey of about 5,500 physicians, 72% said that not being able to bill for consultations had decreased their total revenues by more than 5%, with about 30% reporting their revenues had fallen more than 15%.

The loss of revenue has in turn had an impact on physicians’ practices. For example, 20% of respondents said they have already reduced the number of new Medicare patients seen in their practices. Additionally, 39% said they will hold off on purchasing new equipment or health information technology.

The policy change may also undermine efforts to improve patient care coordination. About 6% of responding physicians said they have stopped providing primary care physicians with written reports following consults with Medicare patients, and another 19% said they plan to do so.

In a letter to the CMS, officials from more than 30 medical specialty societies, including the American College of Physicians, the American College of Gastroenterology, the American Geriatrics Society, and the Society of Thoracic Surgeons, urged the agency to revise the policy when they issue a final regulation on the 2011 Medicare Physician Fee Schedule this fall. The organizations suggested that the CMS consider paying consulting physicians for providing the referring physician with a comprehensive report.

They also said the CMS could ease some of the financial pressure on physicians by revising its guidelines for prolonged visits to allow for reimbursement for services provided outside of the face-to-face visit, such as reviewing charts and communicating with families and other health care providers.

Dr. Philip Marcus, FCCP, comments:
The wholesale elimination of reimbursement for consultations has hurt many physicians whoprovide no procedural servicesbut spend a significant amount of time with a complex patient. The reactions expressed in the survey, viz., limiting Medicare patients and eliminating reports, will likely increase. Also, it is likely that other insurers will follow Medicare’s lead. Unless this situation is remedied, the entire scope of consultations as we knew it will change forever.