Do­ing the math

Modern Healthcare - - Opinions Letters - Lee Balak­law Physi­cian Louisa, Ky.

Re­gard­ing “Up­com­ing CPT reg spurs con­cern” (Mod­ern Physi­cian, Dec. 28, 2009), based on the in­for­ma­tion sub­mit­ted, my cur­rent con­sul­ta­tion rate for a 99245 out­pa­tient code would go from $212.25 to ap­prox­i­mately $157, at cur­rent rates un­der code 99205.

Let’s do the math: $212.25-$157=$55.25, which is a 26% cut. Ac­cord­ing to what Medi­care had told us, a 20% cut in re­im­burse­ment was sched­uled to be­gin Jan. 1, 2010. There­fore, the $157 mi­nus 20% (or $31.40) equals $125.60. From the orig­i­nal $212.25 re­im­burse­ment to $125.60 is $86.65. This is there­fore $86.65/$212.25 or a to­tal of a 41% cut in re­im­burse­ment as of Jan. 1.

Ac­cord­ing to the re­ports, th­ese cuts will be off­set by a 4% in­crease in re­im­burse­ment. So $125.60 in­creased by 4% is an in­crease of $5.02, for a to­tal re­im­burse­ment of $130.62. Based on the orig­i­nal re­im­burse­ment of $212.25, $130.62/$212.25=62% of the orig­i­nal rate, or a cut of 38% from cur­rent rates, even af­ter the in­creased re­im­burse­ment to make things rev­enue neu­tral.

Only in the world of gov­ern­ment bu­reau­cracy is a 38% cut in re­im­burse­ment rev­enue neu­tral. Where is that ex­tra rev­enue go­ing?

When health­care re­form takes place and adds 40 mil­lion more in­sured pa­tients or roughly a 20% in­crease in pa­tient vol­ume in just three years, there will not be a 20% in­crease in physi­cians ready to take care of them. This will in­evitably lead to longer wait times to see physi­cians, which in it­self is a form of ra­tioning. One state has not been will­ing to au­tho­rize any MRI for any pa­tient for any rea­son in over 1½ years. That is an­other form of ra­tioning.

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