The Trump administration announced a plan Friday that would affect about 40 percent of the payments physicians receive from Medicare. Not everybody’s pleased.
The Centers for Medicare & Medicaid Services calls its proposed plan a historic effort to reduce paperwork and improve patient care. But some doctors and advocates for patients fear it could be a disaster.
The CMS plan, published in Friday’s Federal Register, is now open for public comment until early September. It would combine four levels of paperwork required for reimbursement, and four levels of payments, into one form and one flat fee for each doctor’s appointment (although there would still be separate filing systems for new and established patients).
In a letter previewing the plan to doctors earlier this month, CMS Administrator Seema Verma said that physicians waste too much time on mindless administrative tasks that take time away from patients.
“We believe you should be able to focus on delivering care to patients,” Verma wrote, “not sitting in front of a computer screen.”
Initially, that sounded pretty good to Dr. Angus Worthing, a rheumatologist in Washington, D.C. Then he tested the claim with his own analysis.
During a typical 15- to 45-minute appointment with a patient, Worthing figured, “I might spend one to two minutes less in front of the computer, documenting and typing.”
Dr. Kate Goodrich, CMS’ chief medical officer, noted that “saving one to two minutes per patient adds up pretty quickly over time.”
But Worthing said the small savings in time is not worth the reduced payment he’d get. The CMS plan would offer a flat fee for each office visit with a patient, whether the doctor is a primary care physician or a specialist.
Rheumatologists, in general, could expect a 3 percent reduction in Medicare’s reimbursement because they typically see and bill for more complicated patients, said Worthing, who chairs the government affairs committee for the American College of Rheumatology.
And he noted that his personal net income from Medicare patients would drop even more — by about 10 percent. That’s because 70 percent of his costs — for rent, payroll and other expenses — are fixed or rising.
Worthing is leading efforts by rheumatologists to persuade CMS to adjust its funding formula before the plan goes into effect in January.
“The proposal is well-intentioned but it might cause a disaster,” he said, if it leads to fewer medical students going into rheumatology and other specialties that require doctors to manage complex patients. And physicians might stop taking Medicare patients altogether, or avoid those with more difficult problems.
