Medicare - Physician Reimbursement Schedule

MEDICARE

Current rating for PRIMARY CARE PHYSICIAN REIMBURSEMENTS--> * F

Their payments for OFFICE VISITS are--> * ABSURDLY
LOW

Their payments for LAB WORK are--> * NONE

---CURRENT RECOMMENDATION---

Medicare Office Visit payments are pathetic, and they pay us NOTHING for lab work. We keep seeing our Medicare patients only because we love them.

-

---COMMENTS---

3/11/98
MEDICARE GOUGES DOCTORS EVEN DEEPER!
Medicare has just completely eliminated its payments for Venipuncture and Lab Handling. These were always chickenfeed little payments anyway, but they added up over a year. Let's assume that a doctor's practice was composed exclusively of Medicare patients. Medicare used to pay $5 for Venipuncture (drawing a patient's blood); so if we assume that a doctor draws 20 blood tests a day on his patients for 230 working days a year then at $5 a pop that would have produced gross revenues of $23,000 a year - not quite enough to pay the nurse who draws and processes all those samples and fields all the patients from patients about their lab work; but at least it was something.

With the elimination of the Venipuncture fee, Medicare now pays doctors absolutely nothing for lab work (click); yet we must still do the tests in order to take proper care of our patients. Our office staffs must still draw and handle the specimens and receive the reports FOR FREE. Then the doctor must read and use his professional judgement to interpret the significance of the results FOR FREE, give instructions to the nurse to relay to the patient, dictate everything into the chart, and assume TOTAL RESPONSIBILITY for any adverse patient outcome FOR FREE. Someone must then type the doctor's dictation into the patient's chart and refile it FOR FREE.

Who pays for all this service to Medicare patients? The doctor does, of course, out of his own pocket, out of his own takehome pay.

Considering all the other recent Medicare Bad News (click), the only reason that doctors continue to care for our older patients is because of our professionalism and the loyalty we feel to our oaths and our patients. How much longer will doctors be able to keep giving away our labors to subsidize the soon-to-be-bankrupt Medicare system?

I mean, look, doctors have traditionally always taken care of the elderly one way or another, with discounts or even for free if necessary; but if it's going to end up being charity work, let's call it charity; so everyone has a clear understanding who's doing the giving and who's receiving.
-------------------

.

2/2/98
HERE'S THE LATEST MEDICARE RIP-OFF
Medicare has now decided that it will pay nothing whatsoever for a Quick-Strep Test (86588) or a Blood Glucose (82947) done in a doctor's office, tests which it now considers to be "part of the office visit charge". Medicare is thus saying to the doctor, "Look, if you think these tests are so important, then you must pay for them out of your own pocket because we (Medicare) are not going to." How absurd it is that out of one corner of its mouth the government criticizes doctors for the "overuse of antibiotics" while at the same time altering its Medicare fee schedule to give us a potent disincentive from performing the simple, fast Quick-Strep Test that can help us determine which patients truly must receive antibiotic therapy and which ones do not need antibiotics.

Let's look at the economics of this ludricous policy. For simplicity, doctor, assume that your out-of-pocket cost for a Quick-Strep test is $5 for the test materials and staff time. We assume that you do 1,150 of these in your office per year; so Medicare just stole another $5,750 from you. But keep in mind that we're not talking here about just reduced potential income -- if you determine that these tests are important and decide to absorb the cost yourself, that added overhead cost is being subtracted directly from your other income. Obviously the "smart" thing for a doctor to do financially would be simply to stop checking for strep in Medicare patients and give every one of them antibiotics (even though that would increase the patient's overall cost of care and expose some to unnecessary antibiotics). Unfortunately, then we'd be practicing lousy medicine, and most of us are unwilling to do that... Catch-22.

Oh, and if we assume that you perform one Blood Glucose every day (formerly paid at $5.57), you'll be donating to the Medicare system yet another $1,281 of your takehome pay this year.

No wonder many Primary Care doctors are becoming ever more strongly tempted to drop out of Medicare altogether (click).

What's WRONG with the bureaucrats who are making these dumb policies? Surely they're not doctors!
---------------

1/19/98 MEDICARE just lowered its reimbursement for a Blood Glucose from $5.84 to $5.57, a drop of 5%. If we assume that you do just one of these a day in your office to monitor your patients with diabetes, then Medicare just lowered your annual income by another $62.10. I agree that this doesn't seem like much; but, as we've said so many times on this site, a little here, a little there... it's like being eaten to death by ants. The trend is inexorably downward.
---------------

12/18/97 Medicare just lowered its reimbursement for an Electrocardiogram from $47 to $30.99, a drop of 34.1%. We assume you do 690 of these a year, doctor; so the government just "taxed" you another $11,047 to subsidize the government's promises to patients that it can't afford to keep.
--------------

12/18/97 Medicare just reduced its fee for a Pulmonary Function Test from $50 to $34.90, a drop of 30.2%. We assume you do 230 of these tests a year; so you were just forced to underwrite the Medicare system by
another $3,473 worth of your labor, doctor.
--------------

8/18/97 Physicians are prohibited by law from charging Medicare-eligible patients any more than the fees below. No matter how wealthy someone may be, it is illegal for them to pay their doctor what they think he is worth to them. The government makes the promises to Medicare patients, but everyone needs to understand that we doctors are the ones who are actually underwriting the Medicare system; since the fees don't even cover our overhead.

-----------

PLEASE BOOKMARK http://home.earthlink.net/~austintxmd and check often for updates

NET PHYSICIAN INCOME

MEDICARE

If you saw patients only from Medicare for a full year, this is what you would earn.

Maximum Number of Each Click to see ASSUMPTIONS on which these figures are based

You Could Perform Fee
They Pay Totals
For Year

___Service____
Per Year

Office Visits (99212) 4,140 29.73 $123,082

Physical Exams (99215) 690 100.79 $69,545 HOURLY

Total Possible Income from Office Visit Charges--> $192,627 $167.50 Income

Total OFFICE OVERHEAD (click)--> -$206,600 __-$179.65 Overhead

Net ANNUAL PHYSICIAN INCOME--> -$13,973 -$12.15 <-- Net HOURLY MD Income

Hourly Physician "Wage" (based on an 8-hour day)--> -$7.59

INSURANCE REIMBURSEMENT AMOUNTS
(including patient copay)

CPT Code Description 1995 Payment Current Payment CHANGE

99211 Office Visit, MInimal 14.38 15.19 5.6% Payment For
<-- 4 Office Visits

99212 Office Visit (10min.) 27.14 29.73 9.5% $118.92

99213 Office Visit (expanded) 41.31 42.42 2.7%

99214 Office Visit (detailed) 63.93 7.5% Payment For One
<-- Physical Exam

99215 Physical Exam (40min.) 88.00 100.79 14.5% $100.79

93000 Electrocardiogram 47.00 30.99 -34.1% -$18.13 <-- What the doctor loses every time he does a thorough physical exam. See "Disincentives to Good Care"

94010 Pulmonary Function 50.00 34.90 -30.2%

85025 Complete Blood Count None None

81000 Urinalysis None None

80061 Cholesterol/LDL/HDL None None

80019 Chem-28 Profile None None

88150 Pap Smear None None

---------

Reprinted from: http://home.earthlink.net/~austintxmd

Introduction It's Not Insurance Any More Greedy Insurance Exec Dedicated Doc Graphic

Introduction for Doctors PPO or HMO - Both are BAD GUYS

Doctors Are the GOOD GUYS "Disincentives" to Good Care

Doctors' Income Business is Business

The Effect on Doctors What Can Be Done?

Send E-MAIL to AustinTxMD Compare Insurance The Latest Bad News

MEDICARE

Current rating for PRIMARY CARE PHYSICIAN REIMBURSEMENTS-->		*	F
	Their payments for OFFICE VISITS are-->	*	ABSURDLY LOW
	Their payments for LAB WORK are-->	*	NONE
	---CURRENT RECOMMENDATION---
Medicare Office Visit payments are pathetic, and they pay us NOTHING for lab work. We keep seeing our Medicare patients only because we love them.
	-
	---COMMENTS---
3/11/98	MEDICARE GOUGES DOCTORS EVEN DEEPER! Medicare has just completely eliminated its payments for Venipuncture and Lab Handling. These were always chickenfeed little payments anyway, but they added up over a year. Let's assume that a doctor's practice was composed exclusively of Medicare patients. Medicare used to pay $5 for Venipuncture (drawing a patient's blood); so if we assume that a doctor draws 20 blood tests a day on his patients for 230 working days a year then at $5 a pop that would have produced gross revenues of $23,000 a year - not quite enough to pay the nurse who draws and processes all those samples and fields all the patients from patients about their lab work; but at least it was something. With the elimination of the Venipuncture fee, Medicare now pays doctors absolutely nothing for lab work (click); yet we must still do the tests in order to take proper care of our patients. Our office staffs must still draw and handle the specimens and receive the reports FOR FREE. Then the doctor must read and use his professional judgement to interpret the significance of the results FOR FREE, give instructions to the nurse to relay to the patient, dictate everything into the chart, and assume TOTAL RESPONSIBILITY for any adverse patient outcome FOR FREE. Someone must then type the doctor's dictation into the patient's chart and refile it FOR FREE. Who pays for all this service to Medicare patients? The doctor does, of course, out of his own pocket, out of his own takehome pay. Considering all the other recent Medicare Bad News (click), the only reason that doctors continue to care for our older patients is because of our professionalism and the loyalty we feel to our oaths and our patients. How much longer will doctors be able to keep giving away our labors to subsidize the soon-to-be-bankrupt Medicare system? I mean, look, doctors have traditionally always taken care of the elderly one way or another, with discounts or even for free if necessary; but if it's going to end up being charity work, let's call it charity; so everyone has a clear understanding who's doing the giving and who's receiving. ------------------- .
2/2/98	HERE'S THE LATEST MEDICARE RIP-OFF Medicare has now decided that it will pay nothing whatsoever for a Quick-Strep Test (86588) or a Blood Glucose (82947) done in a doctor's office, tests which it now considers to be "part of the office visit charge". Medicare is thus saying to the doctor, "Look, if you think these tests are so important, then you must pay for them out of your own pocket because we (Medicare) are not going to." How absurd it is that out of one corner of its mouth the government criticizes doctors for the "overuse of antibiotics" while at the same time altering its Medicare fee schedule to give us a *potent disincentive* from performing the simple, fast Quick-Strep Test that can help us determine which patients truly must receive antibiotic therapy and which ones do not need antibiotics. Let's look at the economics of this ludricous policy. For simplicity, doctor, assume that your out-of-pocket cost for a Quick-Strep test is $5 for the test materials and staff time. We assume that you do 1,150 of these in your office per year; so Medicare just stole another $5,750 from you. But keep in mind that we're not talking here about just reduced potential income -- if you determine that these tests are important and decide to absorb the cost yourself, that added overhead cost is being subtracted directly from your other income. Obviously the "smart" thing for a doctor to do financially would be simply to stop checking for strep in Medicare patients and give every one of them antibiotics (even though that would increase the patient's overall cost of care and expose some to unnecessary antibiotics). Unfortunately, then we'd be practicing lousy medicine, and most of us are unwilling to do that... Catch-22. Oh, and if we assume that you perform one Blood Glucose every day (formerly paid at $5.57), you'll be donating to the Medicare system yet another $1,281 of your takehome pay this year. No wonder many Primary Care doctors are becoming ever more strongly tempted to drop out of Medicare altogether (click). *What's WRONG* with the bureaucrats who are making these dumb policies? Surely they're not doctors!** ---------------
1/19/98	MEDICARE just lowered its reimbursement for a Blood Glucose from $5.84 to $5.57, a drop of 5%. If we assume that you do just one of these a day in your office to monitor your patients with diabetes, then Medicare just lowered your annual income by another $62.10. I agree that this doesn't seem like much; but, as we've said so many times on this site, a little here, a little there... it's like being eaten to death by ants. The trend is inexorably downward. ---------------
12/18/97	Medicare just lowered its reimbursement for an Electrocardiogram from $47 to $30.99, a drop of 34.1%. We assume you do 690 of these a year, doctor; so the government just "taxed" you another $11,047 to subsidize the government's promises to patients that it can't afford to keep. --------------
12/18/97	Medicare just reduced its fee for a Pulmonary Function Test from $50 to $34.90, a drop of 30.2%. We assume you do 230 of these tests a year; so you were just forced to underwrite the Medicare system by another $3,473 worth of your labor, doctor. --------------
8/18/97	Physicians are prohibited by law from charging Medicare-eligible patients any more than the fees below. No matter how wealthy someone may be, it is illegal for them to pay their doctor what they think he is worth to them. The government makes the promises to Medicare patients, but everyone needs to understand that we doctors are the ones who are actually underwriting the Medicare system; since the fees don't even cover our overhead.
	-----------
PLEASE BOOKMARK http://home.earthlink.net/~austintxmd and check often for updates

NET PHYSICIAN INCOME
MEDICARE

If you saw patients only from Medicare for a full year, this is what you would earn.

	Maximum Number of Each				Click to see ASSUMPTIONS on which these figures are based
	You Could Perform		Fee They Pay	Totals For Year
	___Service____	Per Year	Fee They Pay	Totals For Year
Office Visits (99212)		4,140	29.73	$123,082
Physical Exams (99215)		690	100.79	$69,545		HOURLY
Total Possible Income from Office Visit Charges-->				$192,627		$167.50	Income
Total OFFICE OVERHEAD (click)-->				-$206,600		__-$179.65	Overhead
Net ANNUAL PHYSICIAN INCOME-->				-$13,973		-$12.15	<-- Net HOURLY MD Income
							<-- Net HOURLY MD Income
Hourly Physician "Wage" (based on an 8-hour day)-->						-$7.59

INSURANCE REIMBURSEMENT AMOUNTS (including patient copay)
CPT Code	Description	1995 Payment	Current Payment	CHANGE
99211	Office Visit, MInimal	14.38	15.19	5.6%		Payment For <-- 4 Office Visits
99212	Office Visit (10min.)	27.14	29.73	9.5%	$118.92	Payment For <-- 4 Office Visits
99213	Office Visit (expanded)	41.31	42.42	2.7%
99214	Office Visit (detailed)		63.93	7.5%		Payment For One <-- Physical Exam
99215	Physical Exam (40min.)	88.00	100.79	14.5%	$100.79	Payment For One <-- Physical Exam
93000	Electrocardiogram	47.00	30.99	-34.1%	-$18.13	<-- What the doctor loses every time he does a thorough physical exam. See "Disincentives to Good Care"
94010	Pulmonary Function	50.00	34.90	-30.2%
85025	Complete Blood Count	None	None
81000	Urinalysis	None	None
80061	Cholesterol/LDL/HDL	None	None
80019	Chem-28 Profile	None	None
88150	Pap Smear	None	None
---------
Reprinted from: http://home.earthlink.net/~austintxmd


Introduction	It's Not Insurance Any More
Introduction for Doctors	PPO or HMO - Both are BAD GUYS
Doctors Are the GOOD GUYS	"Disincentives" to Good Care
Doctors' Income	Business is Business
The Effect on Doctors	What Can Be Done?
	Send E-MAIL to AustinTxMD	Compare Insurance	The Latest Bad News