The Trump administration wants to change the way Medicare pays doctors for office visits by creating a flat payment of about $135 for all appointments. The change is intended to reduce paperwork significantly but is meeting resistance from specialists who say they will be underpaid for their services, which could result in more doctors refusing to see Medicare patients.
Currently, there are five levels of Medicare office visits, each with its own payment amount, ranging from a short visit with a nurse (level 1) to an in-depth evaluation from a specialist (level 5). Visits with doctors typically start at level 2, with a current billing rate for new patients of $76, and move up in complexity to level 5, with a billing rate of $211.
Not all doctors would lose out, since less complex visits would be billed at a higher rate under the proposal, but the specialists currently billing at the top level would see a reduction in fees. “This proposal is likely to penalize physicians who treat sicker patients, even though they spend more time and effort and more resources managing those patients,” Deborah J. Grider, an expert on the subject, told The New York Times.
On the other hand, the proposal would reduce the time-intensive requirement to document the different levels of services, particularly at the upper end. “The differences between Levels 2 to 5 are often really difficult to discern and time-consuming to document,” Dr. Kate Goodrich, Medicare’s chief medical officer, told the Times.
One thing the proposed billing system won’t change is the overall cost of spending on physician services under Medicare. While the proposal would redirect some of the fees from one set of doctors to another, spending would remain at roughly $70 billion a year.