The Community Oncology Alliance made a similar observation.
“CMS is proposing to drastically cut payment for the critical evaluation and management of more complex cancer cases from $172 to $135 (a 22% payment cut) for a new patient and from $148 to $93 (a 37% payment cut) for an existing patient. Although CMS is proposing to streamline the reporting of these cases, the proposal severely undervalues the thorough and critical evaluation and management of seniors with cancer, especially life-threatening complex cases,” the organization said in a statement.
Dr. Worthing said the proposal has implications for recruiting medical trainees into rheumatology and for physicians in practice who may be considering whether to stop seeing Medicare patients. “Since we already have a shortage of rheumatologists in the U.S. that, per the ACR’s recent study, appears to be worsening, we are pretty concerned that if this proposal is finalized, we could be facing a situation with longer wait times to see a rheumatologist,” he said.
But Dr. Worthing praised the proposed reduction of documentation and said that it could save physicians some time. “If this proposal were finalized, I might be able to spend a minute or two less typing or documenting in a typical patient visit,” he said. “That might add up over time to seeing more patients.”
Seema Verma
CMS officials estimate the proposal would save a lot more time. CMS Administrator Seema Verma said that the documentation change would result in an additional 51 hours for patient care per clinician per year.
However, Dr. Worthing said he was doubtful that any increase in volume would offset the losses from the proposed flat payment across levels 2-5 E/M visits, especially if the pay decrease results in access issues. “If doctors were seeing less and having a harder time covering their business expenses seeing Medicare patients, they might be incentivized to see more commercially insured patients and maintain their practice’s viability that way and not participate in Medicare anymore,” he said.
***This story was updated 8/8/2018.
SOURCE: CMS proposed rule, CMS-1693-P.