The last 39 hours of my life, edited for the reader to not include periods of sleep, have been filled with catharsis and increased awareness that time and change keeps coming.
Wednesday evening, I went to a local concert venue to see Bob Mould, a legend of punk rock and college radio, who informed the audience that he turned 50 a week ago. I have been listening to Bob in his many musical permutations for over 20 years, from the frenetic to the introspective, and despite the fact that it was his usual great show, you begin to feel the metaphorical vultures circling when your musical heroes get the AARP card in the mail. I’m still struggling internally with how I feel about this fact.
Yesterday, I spent the day at a seminar put on by the Wisconsin Medical Society regarding upcoming changes to the Medicare program. With the idea that change can be either good, bad or ugly, depending on how it is approached, I present an assortment of changes for the coming year, complete with hypnosis exercises to temporarily distract you from just how terrible the results of some of these changes could be.
As you lay back and begin to relax, I can at the very least start with some good news for providers with specialty designations of primary care, internal medicine, pediatrics and geriatrics. Beginning in January, and extending through the end of 2015 (dire Mayan calendar warnings not withstanding), physicians and mid-level providers with these specialty designations are eligible for a quarterly bonus of 10% if at least 60% of the allowed charges are from certain E/M codes. In the same time frame, general surgeons are also eligible for a 10% bonus if they perform surgical services with a 10 or 90-day global period in a Health Care Professional Shortage Area (HPSA).
As I swing a pocket watch in front of your eyes and you feel your eyelids getting heavier, I bring you news of an expansion of preventive care in the Medicare program. Beginning January 1, 2011, Medicare beneficiaries will be eligible for an annual wellness visit. While this development is long overdue, there are three problems with this benefit, the first of which is that any Medicare contracted provider can perform this visit. As only one visit is allowed per year, it will be up to aging patients and frustrated office staff to track one visit in a 12-month span. Second, the “Welcome to Medicare” visit and the new annual wellness visit cannot both be paid within the same 12-month period, which becomes yet another tracking headache. Finally, the documentation standards for the annual wellness appear to be just as onerous as the “Welcome to Medicare” visit. For me, this provides a training opportunity. For the physician community, this represents an opportunity to yell and give dirty looks to the person providing the training.
As you feel all the tension disappear from your neck, shoulders and spine with your eyes completely closed, listening to the cool, clear water running in the happy place of your mind’s eye, I remind you again of the major expansion of payment audits. The Obama Administration has vastly expanded the audit programs centered around the Medicare and Medicaid programs, in addition to the expansion of the Recovery Audit Contractor program into Medicaid in 2011, there is also a relatively new and aggressive entity referred to as the HEAT Task Force, a combined effort by the Department of Justice and the Department of Health & Human Services to make the combating of health care fraud a cabinet-level priority. Recent testimony pegged the amount of fraud in the Medicare system at $54 billion for 2009. The stated goal is to reduce this number 50% by 2012. For those of you in the reading audience who aren’t calendar enthusiasts, there are only 435 days left until 2012. Things are about to get nasty in the audit world.
As you watch glitter-throwing sprites flit above marzipan flowers and waterfalls of pure, sweet Merlot wine, the biggest change is one that has yet to be corrected, this being the ongoing threat of drastic percentage reductions to the Medicare Physician Fee Schedule. Without action in the upcoming post-election, lame duck sessions of Congress, a 23% reduction is set to be implemented on December 1st, 2010. Thanks to the ongoing fire drills of Spring with regard to this issue, we know that CMS can place a hold of ten working days on claims, which makes the actual deadline to fix this life-altering decrease December 14th. As if this wasn’t enough, the fee schedule for 2011 currently includes an additional reduction of 6.1% which takes effect January 1st. It remains to be seen whether the last session of the current Congress will be in the mood to alter a landscape that puts the health care, and by extension the lives, of Medicare beneficiaries, at risk. The Senate being the place where useful legislation goes to die, you’ll pardon me for my skepticism this time around.
When you open your eyes, you will remember everything. Welcome back to the new reality. A snifter of brandy and a few Valium can be found on the small table near the exit.