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Sleep Physicians Getting Whacked by Medicare
from the AASM:
The recent publication of the 2011 Physician Fee Schedule Final Rule has introduced severe payment cuts for services to Medicare and TRICARE patients...projected to surpass 30 percent for sleep physicians on January 1, 2011!
Views: 702
Replies to This Discussion
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Permalink Reply by Melinda Hertel on
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Medicare sets allowed reimbursement, no matter what a DME or physician charges. Many insurance companies follow Medicare guidelines. If a DME is contracted with Medicare or insurance companies, it has to charge the same contracted price for everyone. That is why the company I work for does not contract with insurance--so we can provide equipment at lower prices. Our sleep lab does charge a lower fee for cash paying patients for testing--apparently labs can do that but DME's cannot. The overhead at a sleep lab is huge--sleep techs are expensive. Our lab charges far less than 4k--perhaps that is a function of the region you live in. Still, just because you charge that much doesn't mean that's is what insurance pays.
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Permalink Reply by RichM on
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Rock, I guess I have only seen the high cost due to having complex sa and I was on a bipap s/t before this and before that other machines I have had my problems for many years now and it is good that I have found a machine that works for me now. thanks for your incite.
Rich
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Permalink Reply by 99 on
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FYI the gov sets the price of the sleep studies and the Dr. Fees. and the Dr try to keep up with the polictions salary and yet it is the doctors who are blamed as greedy as they try to match the politions
it is true prices need to be driven down but this needs to start at the top EG with the policy makers
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Permalink Reply by RockRpsgt on
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So insurance companies are the problem! Where have I heard that before?
Great posts Melinda!
Melinda Hertel said:Medicare sets allowed reimbursement, no matter what a DME or physician charges. Many insurance companies follow Medicare guidelines. If a DME is contracted with Medicare or insurance companies, it has to charge the same contracted price for everyone. That is why the company I work for does not contract with insurance--so we can provide equipment at lower prices. Our sleep lab does charge a lower fee for cash paying patients for testing--apparently labs can do that but DME's cannot. The overhead at a sleep lab is huge--sleep techs are expensive. Our lab charges far less than 4k--perhaps that is a function of the region you live in. Still, just because you charge that much doesn't mean that's is what insurance pays.
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Permalink Reply by Donald R. Byrd on
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As a healthcare provider RRT for a home care company we offer services and equipment to patient's that need professional care that takes time which cost money. My company has a great cpap compliance rate its very high 90% and for good reason we work hard to provide the needed services to our patient's ensuring patient's sleep apnea is treated optimally initially and ongoing... This type of care is not easy and fortunately or unfortunately it does cost money.
Buying it from a local Pharm at a tenth of the price? Is it really a good idea shopping at Mega Mart for a Generico pap mask? Dew ya think they will let you take it off the shelf and try each one on before you purchase it for 7.99. Yeah, maybe it can be set up like the shoe department.
Bob Plugh said:But, at 4k a wack, who can just saunter in and say give me a sleep test please. a few hundred dollars, maybe, 4k, no way. This price is just out of line and it is the physicians and other entities including hospitals that set these outrageous amounts. They're just being as greedy as possible.
I think your viewpoints about DME companies are out of wack too. DME companies love to sell this stuff because the overhead is so outrageous. xPAP consumables should be a tiny fraction of what they actually charge. These DME companies are making money hand over fist by selling this stuff. Once it gets sold in the local pharmacy, the price will drop substantially, probably down to somewhere between one quarter to one tenth what it is now.
Melinda Hertel said:I have to say that having worked with physicians for 14 years, I don't see how they have a choke hold on any medical field. Physicians cannot charge patients for writing prescriptions for anything--they can only charge for office visits and medical procedures. Many doctors require an annual follow-up visit in order to renew prescriptions, but that is for a couple of reasons. First, many insurance companies require office visit notes to authorize new prescriptions for equipment--they want to make sure we are not charging for equipment that we didn't provide and make sure the patient is being followed and using the stuff they are paying for. Second, a good physician does not practice medicine without seeing their patients once in a while. In our practice we allow patients to have equipment prescriptions for 2 years without having to see the physician--but all of the physicians I work with would be happy not to have to write prescriptions for CPAP equipment. It is time-consuming for the office staff and the physicians to provide prescriptions, fax them to the DME's, etc. and they don't get paid for it.
I also find that as a DME provider it is a pain in the butt to have to get a prescription for CPAP supplies. Running a DME and having to deal with other DME companies, I believe that none of us want to require a prescription. It would be so great if a patient could walk in and just buy a mask!
As far as testing goes, anyone can go in for a test or do a home test without a prescription if they want to pay for it themselves. Insurance companies, especially Medicare, are the ones who require testing to prove that the patient needs the stuff, or they won't pay.
So basically, I guess I'm saying that the blame needs to be placed on the right entity. Physicians and DME's don't care about prescriptions--insurance companies and Medicare does. Unfortunately, the law requiring prescriptions applies to even the cash pay people when it comes to equipment. But, I have a hard time believing that labs and physicians doing home testing would deny patients the ability to be tested if they want to pay for it.
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Permalink Reply by Mary Z on
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Sure Doctors get paid for writing prescriptions and even faxing them to the DME, or giving them to the patient. It's the cost of overhead and the physicians practice. When I see what these guys (or women ) charge for a visit I cringe at the cost. What Medicare allows seems a much more reasonable price.
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Permalink Reply by RChatty on
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Oh, I love that one! Perfect description. I work for an early intervention center and that's EXACTLY how it is. We can't just serve the children anymore. The whole goal is to make the paperwork look good (according to the state). Our new job is to sit there and document how the parent plays with their child.
j n k said:The amount the doc charges is to pay the huge staff needed to process the paperwork.
Being a doc is no longer about treating people. It is about facilitating the documenting of the treating of people.
Most of what is paid goes into the process of creating the paper trail, not into paying for the medical treatment itself.
Ya gotta love an agency that creates more paperwork to be filled out in order to prove to the agency that less money should be paid to the people doing the paperwork that the agency demands.
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Love it. That is very true for doctor's offices. And for sleep labs, sleep technicians are very specialized and have to work the crappy hours nobody really wants to work. So they need to be paid for what they do. It's a LOT of overhead.
j n k said:The amount the doc charges is to pay the huge staff needed to process the paperwork.
Being a doc is no longer about treating people. It is about facilitating the documenting of the treating of people.
Most of what is paid goes into the process of creating the paper trail, not into paying for the medical treatment itself.
Ya gotta love an agency that creates more paperwork to be filled out in order to prove to the agency that less money should be paid to the people doing the paperwork that the agency demands.
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Let's not forget the cost of malpractice insurance that medical providers must have. Yes, there needs to be a system in place to protect those injured or who die as the result of a bad medical procedure or drug, but the overly litigious natiure of today's society would, I think, play a big role in what a doctor has to charge to stay in business. It's not perfect, but just a fact of life today.
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Permalink Reply by D. W. Conn on
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All this medicare will pay will not pay is driving me nuts. I work for a for profit Hospital System...we hear as the wind changes if Medicare cuts we have to cut staff or cut the lab all together. Its so much crap almost daily I swear I have post tramatic stress from not knowing if we will have jobs or not. The winds of change blowing in healthcare makes you forget why you came to work in healthcare in the first place. Forget the science, forget the care you give just be sure and cross that T or dot that i otherwise the study is refused. There is so much charting going on during a consult you can not even remember what your patient looked like. I am just sick of everything about healthcare at the moment. Really 29 years of healthcare service for what...this?
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It not just healthcare… people complain about what Physicians make, let me tell ya if they make 250K a year saving lives good for them. We buy expensive football, baseball, and even concert tickets allowing salaries in the millions for guys to run around on a field and live lives most of us couldn’t even fathom.
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I agree, and look at our teachers, fire and policemen. Our values are screwy.
D. W. Conn said:It not just healthcare… people complain about what Physicians make, let me tell ya if they make 250K a year saving lives good for them. We buy expensive football, baseball, and even concert tickets allowing salaries in the millions for guys to run around on a field and live lives most of us couldn’t even fathom.
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