There are an abundance of good experts frequently found discussing important points in the world of meaningful use, both in print and in the blogosphere. However, a friend and I were recently discussing the plans and released information for meaningful use and noted that many of the experts do not seem to be practicing providers who will directly participate in meaningful use. Thus, the following considerations are not often discussed (as far as I’ve seen) but ones that I think merit attention.
1. On January 1 2010, Medicare rescinded the ability of subspecialist physicians to use “consultation codes” for billing, which partially offset their increased reimbursements to primary doctors. This meant that subspecialists would now get the same pay as a primary provider (e.g. gneral internist or family physician) for a given patient visit. Aside from royally peeving subspecialists who have trained long and hard to obtain special insights into how to manage complex patients with problems in their areas of advanced training, Medicare was able to lower reimbursements to subspecialists by about 15% per patient seen. As a result, subspecialty professional organizations such as the American Association of Clinical Endocrinologists (AACE), issued surveys of their own members asking for documentable proof of the obvious, that increasing numbers of subspecialists either (1) are not applying to become participating providers who accept Medicare patients or (2) are in the process of opting (dropping) out.
As more and more subspecialists drop out of Medicare, more and more elderly patients will have to go without subspecialty care when they may most need it, and more and more elderly will have to pay cash, out of shallow pockets, to see expensive subspecialty care providers. This means, of course, more bad news for complex elderly patients. Moreover, because many academic hospitals are required to accept Medicare patients, these hospitals sparse subspecialist providers will become overloaded and unable to see Medicare patients within an appropriate time period after diagnosis with a complex problem. In my own field, endocrinologists who practice at academic hospitals typically take 3-4 months or more to see a new patient.
What does this all mean for Meaningful Use? Less participating providers in the private sector and small practices, less data submitted for research purposes, and more heads being scratched wondering what the whole point was to begin with, IMHO.
Considerations 2-6 (or so) coming soon!
Dr. West is an endocrinologist in private practice in Washington, DC. He completed fellowship training in Endocrinology and Metabolism at the Johns Hopkins University School of Medicine. Dr. West opened The Washington Endocrine Clinic, PLLC, as a solo practice in 2009. He can be reached at email@example.com.