Medicolegal Issues

SHM Should Create Task Force to Explore Reimbursement Methodology Change


One of the The Hospitalist newsmagazine’s features over the years is frequent articles educating physicians about Medicare reimbursement. Nothing wrong with that. Reimbursement for “sepsis” is better than for “urosepsis,” and that’s important for us to know.

However, I think it’s about time that we physicians take a stand and try to change some of the ridiculous word games going on in Medicare reimbursement circles. Why do we stand idly by and let some bureaucrat decree that if we write “urosepsis,” Medicare reimburses markedly less, even though we are treating exactly the same thing if we write “sepsis from UTI”? Why are we not fighting the asinine “bullet” system, in which we get substantially “downcoded” if we miss one trivial bullet in our physical exam that has no bearing on our assessment or plan for the patient? Why have we allowed this travesty to pass through unchallenged? Sure, this is the system now and has been, but do we need to continue to accept these inane reimbursement mechanisms?

I propose we develop a team from within SHM, maybe with some help from other physician organizations, to infiltrate, badger, or whatever it takes to advocate change to a reimbursement system that is more intuitive to physicians. The system should reimburse us for the value we add to the patient encounter. For example, how about reimbursement for nonprocedural visits measured not on history/exam bullets but on the complexity of your assessment and plan, including patient/family counseling and/ or care coordination?

Then we can read articles showing what we are doing to change/improve the Medicare reimbursement landscape instead of just learning how to comply with the current system.

Jim Fulmer, MD, site medical director,

Baptist Primary Care Hospitalist System,

Baptist Medical Center— Downtown Campus,

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