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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 Bob Plugh on
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At least this is an area in which physicians are very much overpaid, even moreso than physicians in other areas. I can easily see a 30% reduction, in fact, 50% would not be out of line.
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Permalink Reply by RichM on
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I am glad that I got my asv this year. The problem I see happening is that the cost that is not paid by medicare will have to be paid by us. I agree that the fees that are charged for both the Dr's and for the equipment that we used are high you would think that with more and more people getting help the cost of the equipment at least would come down.
Thanks
Rich
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Permalink Reply by Mike on
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i think it might be a blessing in disguise for sleep physicians to get their rates cut back. the reason physicians and labs have a choke hold on the industry -- i.e., no ability for patients to buy an OSA test or CPAP mask or machine without a prescription -- is because it's been far too lucrative for the physicians and labs the way things have been to let anyone else in. As they lose that financial incentive to keep control, they won't care as much when others who want to provide tests and treatments for OSA sell direct to consumer: when Sony or GE or some other consumer facing company manages to get these things sold in Best Buy and Target.
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Permalink Reply by Steven Y. Park, MD on
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This is the same issues for Medicare that keeps coming up every few years threatening to cut rates that were set years ago using a flawed formula. I guarantee that congress will pass a bill at the last minute delaying this cut for another few months or years. Congress and the medical community will applaud themselves for avoiding a major disaster. Then in the next few months to years, it'l happen again.
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Permalink Reply by Melinda Hertel on
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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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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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Medicare and insurance companies set their policies against a backdrop of frantic physician lobbying efforts -- the reason prescriptions are required is that the sleep docs who run the sleep labs wanted it that way -- and came up with the scientific research to support the need for them to remain in the loop. back in the day, and even in some parts of the country now, sleep labs got BIG BUCKS to run an overnight sleep study. if the patient had to come hat in hand to the physician every time they had to take a pi*s (i.e., get a mask part replaced, change pressure settings, get retitrated), there was HUGE increased likelihood that the physician writing the prescription could persuade the patient to do one of these overnight studies. so that made economic sense for them to maintain the death grip over patients freedom of choice. Nowadays, Medicare and insurance is catching on to this little racket, and slashing reimbursement for sleep studies like there's no tomorrow. so now the conditions exist more and more which you describe -- fewer physicians owning sleep labs, more sentiment among docs that the prescription requirement is nothing but a pain in their a*s. but that's a new development. either way you cut it though, it supports my argument to lift the prescription requirement.
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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These cuts when enacted were scheduled to be implemented in small chunks over many years. Each scheduled physician reimbursement cut has been pushed back to the next by elected officials bowing to the threat of the AMA lobby.
Medicare + Medicaid (CMS) underfunding is the greatest single threat to our federal government's solvency. To correct the problem we can cut spending, increase taxes, or increase borrowing. I favor cutting spending by both limiting eligibility (by age, means testing, etc.) & cutting spending. The current 20-30% single cuts are too harsh all at once, so smaller cuts should be implemented immediately with more to follow as needed.
Fixing the CMS deficits is going to hurt. It will hurt those who get fewer benefits, & it will hurt providers who get paid less. We all participated in letting it get this bad, & we all should commit to paying the painful price to correct the underfunding before we pass it along to our children, who have not yet made the poor choices we made to get us into this mess. Let's suck it up & do the right thing.
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Rich, the costs of PAP have come down remarkably, but ASV is relatively new technology & hasn't had as much time to moderate as have other PAP therapies.
Rock
RichM said:I am glad that I got my asv this year. The problem I see happening is that the cost that is not paid by medicare will have to be paid by us. I agree that the fees that are charged for both the Dr's and for the equipment that we used are high you would think that with more and more people getting help the cost of the equipment at least would come down.
Thanks
Rich
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Buying the cpaps or asv units at best buy that's got to be the foolish thing I have heard of yet, and FYI the gov sets the price of the sleep studies and the Dr. Fees.
Mike said:i think it might be a blessing in disguise for sleep physicians to get their rates cut back. the reason physicians and labs have a choke hold on the industry -- i.e., no ability for patients to buy an OSA test or CPAP mask or machine without a prescription -- is because it's been far too lucrative for the physicians and labs the way things have been to let anyone else in. As they lose that financial incentive to keep control, they won't care as much when others who want to provide tests and treatments for OSA sell direct to consumer: when Sony or GE or some other consumer facing company manages to get these things sold in Best Buy and Target.
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