Reimbursements are heading the wrong way, fast

September 25, 2013

A reader complains that the reimbursement process has become overly complex and burdensome for providers.

In the August 10, 2013 issue of Medical Economics there are various articles -“Understanding New Payment Models,” “Medicare’s 2014 Fee Schedule,” and “Measuring The ACA Impact”-concerning reimbursement for the services provided by physicians.

It appears that physicians are operating in a fear mode to get justly paid for the services rendered.

When was the last time you were at the store and someone tried to negotiate the price of a gallon of milk?

I am saddened by the pathway reimbursement for services is moving in. This is not something new, it is just expanding in its scope and speed. When I was a medical student and laparoscopic procedures were in their infancy, I heard surgeons complaining that the reimbursement for doing a laparoscopic cholecystectomy was half of what an open procedure paid. It saved payers money because of the shorter length of stay in the hospital, but to the surgeon it made no sense they would be paid less.

Reimbursement has become more complex and burdensome for the work we do. When Medicare first came into being, physicians were told that Medicare would not negatively impact reimbursements for services. Now, the Centers for Medicare and Medicaid Services (CMS) is the driving force behind the rules for reimbursements. Contract reimbursements are based on a percentage of what Medicare pays.

I am not saying the ideas of improving patient care are wrong. I am saying that holding payment based on not meeting “quality measures” is wrong. I would hope that physicians care enough about their patients to do these measures without the stimulus of payment bonuses or penalties.

One sure way of payment protection is to return to payment plans popular in the 1960s:

  • Payment for services are due at the time of appointment.

  • We do not file with insurance companies for payment.

  • We will give the patient a receipt so he or she can file for reimbursement.

Unfortunately, whether physicians want to admit it or not, we have placed ourselves in the wrong area of the triangle when it comes to payment-from between the physician and patient to between the physician and payer. Once this has been corrected, I will no longer have to worry about my payments constantly being negotiated down by insurance payers or dictated by CMS.

What other service or industry has their payments so regulated?

Lawrence Voesack, MD
Odessa, Texas