Our government continues to determine the reimbursement rates for medical procedures, tests and office visits without any meaningful input from physicians. While many in government argue that the American Medical Association is involved in developing codes and reimbursement schedules, they do not represent the majority of American physicians (less than 20 percent of physicians are members of the AMA).
In fact, the AMA and its leadership have become a very wealthy organization due to payments received from their work with the government, specifically, the Centers for Medicare and Medicaid Services. Every single year, there are cuts and changes that occur, and these cuts in reimbursement can harm both doctors and patients. Medicare and CMS influence the entire healthcare market, and private payers almost always follow their lead when it comes to reimbursement changes.
Now more reimbursement cuts are on the horizon, and most appear to be quite arbitrary, which leads me to think the medical lobby is playing a big role yet again in determining healthcare policy and payments to physicians. It is essential that when determining what medical procedure, test, drug, or device is reimbursed (and to what level), that those making the decisions know something about the benefits related to each rather than listen to special interest groups that have no real concern for patient well-being and improved outcomes.
A Reimbursement Case Study: Remote Monitoring
When determining the value or impact of a particular medical device or treatment, institutions such as the AMA and CMS often overlook compelling outcome and economic data. Many patients across the country have implanted cardiac devices such as pacemakers, defibrillators, and cardiac monitors. These devices provide not only life-saving therapies but also can help doctors better manage patients with cardiovascular disease.
Each device has the ability to wirelessly and securely transmit information about a patient’s cardiovascular status and can alert doctors and nurses about early changes or acute problems that may impact a patient’s health and well-being. The management of data that these devices require can be quite time-consuming and requires manpower to process the hundreds of thousands of reports each day—this means a significant expense to a healthcare system and practice that should be reimbursed.
In numerous scientific studies published in high impact journals such as the Circulation, among others, remote monitoring has been shown to improve patient outcomes, decrease hospitalizations (thus saving big money) and provide earlier detection of cardiac problems as well as (in one study) a reduction in stroke. Most importantly, one study actually showed a significant increase in survival when remote monitoring was employed!
Unfortunately, the billing codes for these services are now being considered for cuts—some codes up to 50 percent. Why on earth would Congress discourage the use of a proven therapy that not only saves healthcare dollars but also improves outcomes?
Four words: lack of accurate information.
There are so many data management solutions that are available, such as PaceMate technology, that allow physicians to easily process this information and expand this important service to all patients with cardiac devices with remote follow-up capabilities. It is my hope that Congress will take a closer look at cuts such as these and make a more informed decision this year—hundreds of thousands of patients are depending on it.
A Call to Action
Physicians should be focused on patients and accumulating the necessary knowledge to provide the best treatments possible. Medicine is always evolving and physicians must work very hard to continue to learn throughout their careers. The amount of information that must be processed—through reading journals, attending academic meetings and recertification classes—is massive and time-consuming.
Now doctors have had to also learn more and more about billing and coding—just in the last year, an entirely new government-mandated system called ICD-10 was created. This system has codes for things as ridiculous as “orca bites” and “spacecraft injuries” while other, more valuable (and useful) diagnoses are overlooked.
Electronic Medical Record systems were created in concept to improve patient care. However, in reality, these systems are nothing more than a way to maximize charge capture for healthcare systems. EMR systems have evolved to require that doctors enter billing codes before they can complete a patient care interaction note, thus delaying care and removing the focus from the patient to the computer screen.
Congress must work with real practicing physicians, not just the AMA, in order to ensure they are fairly reimbursing the most vital of physician services. In particular, using patient outcome data as a benchmark for determining reimbursement priorities should be the basis of determining where and when to make cuts.
Healthcare is expensive and we must do more to be cost-effective. Remote monitoring, as described in the case study above, saves hospitalizations, improves outcomes, and ultimately improves quality of life for cardiac patients. We, as physicians and patients, need an open forum with Congress so that we can make sure they understand exactly what is important to all of us—not just to lobbyists or the AMA.
Kevin Campbell (@DrKevinCampbell) is a contributor to the Washington Examiner’s Beltway Confidential blog. He is an internationally-recognized cardiologist and medical, health, and wellness expert. He has authored two books and appears regularly on Fox News, Fox Business, CBS and other media outlets. Dr. Campbell is the CEO of PaceMate, a healthcare data solutions company.
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