CMS Lays Its Codes on the Table

To lay cards on the table – to be very precise about one’s position

Critics like to say the U.S. has no national health system.

The critics are wrong. The CMS (Centers for Medicare and Medicaid) is our national system. CMS accounts for 35% of all health care spending, and along with the AMA’s Relative Value Update Committee (RUC) dictates what 57 specialists (Allergists to Vascular Surgeons) are paid. Health plans and speciality societies invariably follow the CMS lead.

CMS posts its pay codes in November on “Table 93", to which one can access on the Internet.

The total reimbursements listed there is supposedly based on 3 components – relative workload, practice expenses, and malpractice expenses – but I have a sneaking suspicious it rests on the Obama administration philosophy for containing costs. In the eyes of its critics, CMS codes tend to be arbitrary and capricious and malicious towards specialists spenders and soft and supportive of low generalist spenders.

In any event, this year's winners and losers on table 93 are:

Winners

1. Chiropractors, +14%

2. Psychiatrists, +8%

3. Geriatricians, +8%

In addition, the Obama administration says its will pay primary care physicians, general internists, and geriatricians 10% more.

Although not listed, other supposed winners are primary care physicians, who CMS says may be paid $42.60 for each Medicare patients in their panel with 2 or more chronic conditions, if these physicians have EHRs and have the resources to support extensive documentation.

Losers

1. -23% diagnostic testing facilities providers

2. -20% diagnostic laboratories
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3. -17% radiation treatment centers

4. -13% pathologists

5. – 11% oncologists

6. - 7 % neurologists

Many of these changes are arbitrary and reflect the Obama administration thrust to upgrade those specialties which depend on talk and time spent on office visits with downgrading of specialties more reliant on testing, imaging, and interpretation of technological results.

In the background and not listed in table 93 are physicians’ resistance to the ICD-coding overhaul which introduces hundreds of new codes and complicates physicians’ life by requiring them to spending time searching out appropriate codes and hiring new staff to implement billing for the codes.

The ICD-10 overhaul is reminiscent of the healthcare.gov launch. The new coding systems have not been adequately pre-tested. The new codes snarl and confuse the billing process without knowledge on the federal level of the impact on health care practitioners.