Doing the math
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.