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Family Medicine and the Health Care System: Timothy P. Daaleman Reorganizing Medicare for Older Adults with Chronic Illness J Am Board Fam Med 2006; 19: 303-309 [Abstract] [Full text] [PDF]

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Multi-problem reimbursement for Medicare

Nancy E. Ness   (26 May 2006)

Multi-problem reimbursement for Medicare 26 May 2006
Nancy E. Ness, Family Physician Mile Bluff Clinic, Mauston WI Send response to journal: Re: Multi-problem reimbursement for Medicare nness{at}milebluff.com Nancy E. Ness	Surgeons are paid (with a discount) for management of multiple surgical problems at the same session. Medicare should also pay for multiple medical problems managed at the same session -- by allowing multiple E&M's at a single visit with a similar discount for 2nd,3rd, etc problems. The current E&M codes and descriptors, and the examples, only apply to single problems. The decision-making involved in multi-problem chronic care for unstable problems is substantial, but very poorly reimbursed, and contributes to the loss of primary care practitioners in practice and in the training programs -- yet it is the service most efficient for the health care system, and most desired by patients, and within the capability of most Family Physicians and General Internists. In response to the poor pay for coordinated care, the health care system has a pattern of "ping-pong" over-use of referral, which would decrease with incentives for coordinated care -- and would decrease overall health care costs, particularly if coupled with changing the pay for "consults" to equal that for "visits". Preventing abuse would require that "multiple E&M's" be for different organ systems, and that the level of service be determined by the decision-making; just listing a problem, without being involved in decision-making would not justify additional payment. Thus new codes and new descriptors would not be necessary -- just the application of the "multiple procedure" modifier. Although this might not be a perfect solution to the issues presented by the author, it would be an immediate and effective response to the current crisis in chronic health care, by paying for patient-oriented coordination of care, rather than technology and laboratory testing.