Sniffles? Cancer? Under Medicare Plan, Payments for Office Visits Would Be Same for Both

Trump Administration plans to reduce medical office visits to a simplified code and a universal payment regardless of complexity is a step in the right direction - away from complexity and toward simplicity. Devil’s in the details. Docs will fight it tooth and nail. - Sanders DiPiero

WASHINGTON — The Trump administration is proposing huge changes in the way Medicare pays doctors for the most common of all medical services, the office visit, offering physicians basically the same amount, regardless of a patient’s condition or the complexity of the services provided.

Administration officials said the proposal would radically reduce paperwork burdens, freeing doctors to spend more time with patients. The government would pay one rate for new patients and another, lower rate for visits with established patients.

“Time spent on paperwork is time away from patients,” said Seema Verma, the administrator of the Centers for Medicare and Medicaid Services. She estimated that the change would save 51 hours of clinic time per doctor per year.

But critics say the proposal would underpay doctors who care for patients with the greatest medical needs and the most complicated ailments — and could discourage some physicians from taking Medicare patients. They also say it would increase the risk of erroneous and fraudulent payments because doctors would submit less information to document the services provided.

Medicare would pay the same amount for evaluating a patient with sniffles and a head cold and a patient with complicated Stage 4 metastatic breast cancer, said Ted Okon, the executive director of the Community Oncology Alliance, an advocacy group for cancer doctors and patients. He called that “simply crazy.”

Dr. Angus B. Worthing, a rheumatologist, said he understood the administration’s objective. “Doctors did not go to medical school to type on a computer all day,” he said.

But, he added: “This proposal is setting up a potential disaster. Doctors will be less likely to see Medicare patients and to go into our specialty. Patients with arthritis and osteoporosis may have to wait longer to see the right specialists.”


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