Specialists hard-hit by elimination of Medicare consultation codes

The Centers for Medicare & Medicaid Services' Jan. 1 elimination of payments for consultation codes (except for telemedicine services) has resulted in not only lower reimbursements, but also reduced services to Medicare patients and harmed coordination of care, according to the American Medical Association, which teamed with 17 other associations in April to survey physicians about the change.

Of the 5,500 physicians surveyed, 83 percent said that total practice revenues have declined, while 30 percent said they have already cut back on services to Medicare patients. In addition, 20 percent have reduced or eliminated appointments for new Medicare patients, 39 percent will defer the purchase of new equipment and/or information technologies and 34 percent are cutting staff. Six percent have stopped providing consultative reports to primary-care physicians and another 19 percent plan to stop, according to the survey.

According to the AMA, the consultation code survey is part the physician groups' strategy to urge CMS to revise and rework the elimination of the CPT consultation codes within its 2011 rules.

In a June 18 letter to CMS, the societies called out CMS' statement in enacting the 2010 physician payment rule that no one specialty would see Medicare revenue declines of more than three percent--when in reality most specialties saw cuts that were significantly higher.

For example, nearly 75 percent of the neurologist respondents to the survey reported more than a 10 percent drop in revenue, while 57 percent of otolaryngologists reported more than a 20 percent loss in total revenue because of the elimination of consultation codes.

According to the Infectious Diseases Society of America, "Of the more than 500 infectious diseases physicians who completed the survey, nearly all [95 percent] say their total revenue stream has decreased as a result of Medicare's decision. This has led to staff layoffs, less time spent with patients and fewer reports back to referring physicians."

The societies' letter concluded that these problems "could be mitigated by revising CMS guidelines regarding prolonged visits and new patients and/or by creating some mechanism for reimbursing consultant physicians for a comprehensive report back to a referring physician."

To learn more:
- check out the press release from the American Medical Association
- read this Cardiovascular Business piece