Posts Tagged CMS
Wow, you could have had a CPT code and $60. While fee-for-service is widely excoriated for excessive cost what is CMS doing? They want primary care providers or someone to have another fee-for-service. The fee is for “counseling” about lung cancer CT screening and “counseling” about weight loss. Both things that are currently part of an office visit with no additional CPT code — just good patient care.
Both topics could easily be covered on YouTube in several languages but NO — lets do this the old fashioned way and spend a zillion dollars for each provider to reinvent the discussion each time. CMS: don’t be so lazy — make the patient education video and tell primary care providers the URL! And, update the video every 6 months.
The bottom line:
- Lung Cancer CT Screening:
- Don’t do it if the patient can’t have surgery
- Don’t do it until the patient has 30 pk yrs accumulated (number of packs per day times number of years)
- Don’t do it if the patient is less than 55 or over 80 years old.
- Don’t do it if the patient quit smoking more than 15 years ago.
- Weight-loss counseling:
- Say in a loud voice “you weigh too much” then say “eat less”. (that was not so hard!)
- Doctors have been doing this for decades without sustained results.
- There are 20,000 books about diets to loose weight without sustained results.
- This is not going to work — at least be honest.
Follow the money:
Counseling fees for CT scans is an incentive to do the CT scans. The primary care provider makes money, the x-ray office makes money and the radiologist makes money. A better idea is to have the radiology office pay the primary care provider for the counseling out of CT revenue so this is a no-sum-gain. Better yet — make it a provided service under an ACO plan!
Counseling fees for intensive weight-loss is an incentive for lots of repeat visits or a referral. The Primary care provider makes money (and changes from a primary care provider to a specialty provider). The incentive reduces the pool of available visits for primary care with little if any benefit to the vast majority of obese people. A better idea is not to add another CPT code. If the patient needs more time — make another appointment!
Physicians scoff at rules requiring them to use electronic records and now they must pay the penalty.
Melinda Beck reported in the Wall Street Journal 12/18/14 “Medicare to Cut Payments to Some Doctors, Hospitals”. Of the 893,851 physicians in the US, Ms. Beck reports 257,000 will be fined 1% of their Medicare fees for failure to adequately use an electronic medical record.
For example, the technically challenged doctors have failed to use electronic prescriptions, favoring instead marginally-legible hand-written prescriptions. And, they undoubtedly harmed patients by not taking advantage of allergy and interaction checks that are part of electronic prescribing.
AMA president-elect Steven J. Stack is reported as saying he was “appalled” by the government action. Every physician, obviously excluding Mr. Stack, was informed 5 years ago that fines would be imposed in 2014 by Medicare if physicians that bill Medicare fail to use electronic records in a meaningful way.
Why would a rational physician choose not to use an electronic record…?
- Because North Korea might hack the system
- Because the government told them to use an EMR (they give orders, not take them)
- Because they will be retiring soon and won’t need to learn about computers (the real reason)
- Because they will need to pay for a system to help patients
- Because young physicians want the systems, older physicians say no to all this newfangled stuff.
- Because a an electronic record might be used in court against them.
There you have it — a detailed explanation. Appalling, don’t you agree?