Will Reforming Medicare Billing Rules Benefit Patients?

By Brad Klein, MD, MBA

Last month, the federal government proposed changes to Medicare’s billing rules.  The net effect: Doctors will spend less time with their patients. As a physician myself, I know that’s not necessarily a good thing.

The Centers for Medicare and Medicaid Services see the proposal as a simple trade-off.  In exchange for lower reimbursements, physicians will have their documentation requirements reduced.  If doctors spend less time on paperwork, they can see more patients, making up for reduced individual reimbursements by squeezing in more patients each day.  But “less is more” just doesn’t apply here.

Shorter visits can mean not all health concerns get addressed in one visit.  Imagine your aging loved one with several medical issues. Don’t you want the doctor to spend enough time with him or her to talk through each condition and address any concerns?  Illnesses can be complex and connected, needing comprehensive care. Scheduling subsequent appointments to discuss each condition is unnecessary. And waiting for another visit can be dangerous.  

If doctors have less time to gather a patient’s health history and gain a comprehensive understanding of the situation, they may order more, possibly unnecessary tests.  Shorter visits don’t allow time for comprehensive care, which can harm patients in the short and long term.

Disjointed care aside, additional doctors’ visits will require patients to spend more time in transit, more time in waiting rooms and more money on co-pays.  And the doctor-patient relationship will be strained. If the proposed changes are adopted, patients’ sense of quality, personalized care will be replaced with that of feeling like a cog in a factory line.

If CMS is interested in making changes that will benefit doctors and patients, I offer these suggestions:

  1. Remove the extra documentation required to “prove quality.”
  2. Streamline electronic medical records to decrease the number of clicks.  This would allow health care providers the time to have more eye contact with their patients.
  3. Support infrastructure that promotes sharing of medical records across systems so less time is wasted on phone calls and faxes.
  4. Reform prior authorization processes so physicians and their staff spend less time on documentation and patients get more timely access to the medications, diagnostics and procedures they need.

The federal government continues to miss what is important.  Substituting volume for value and taking time away from patients when they need it most is poor health policy, plain and simple.      

If you are interested in protecting the amount of time doctors spend with patients, Medicare is accepting comments on the proposed rule until September 10.  You can “submit a comment” electronically at www.regulations.gov or by mail to the Centers for Medicare & Medicaid Services, Department of Health and Human Services, Attention: CMS–1693–P, P.O. Box 8016, Baltimore, MD 21244–8016.


Brad Klein, MD, MBA, is a board-certified neurologist in Abington, Pennsylvania. He is involved in neurological clinical trials and advocates for patients as a member of the Alliance for Patient Access.

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