It is interesting that at least one specialty is supportive of the elimination: The American Academy of Family Physicians (AAFP). I was upset to read a recent letter to members of Congress from the AAFP supporting the elimination of consultation codes. AAFP contends that the work between a consultation code and new visit are similar. If the codes were brought back, “the policy reversal would result in the further exploitation of these codes, causing rampant billing confusion by medical practices, and ultimately result in Medicare improper and excessive payments.” It isn’t surprising that AAFP is supportive of the elimination when they received an increase in evaluation and management codes. However, I wonder if they understand that without specialists to diagnose and treat complex patients, their patients with rheumatic diseases and other specialty-related health issues will not have access to quality care.
Working for Change
The ACR has been working on this issue since we met with CMS to discuss our concerns in 2009 (Editor’s Note: Click here to read an online exclusive report on the ACR’s meeting with CMS). Our efforts have included trying to get legislative language in the healthcare reform legislation, sending letters to CMS, educating Congress, and working with many other societies. A special thanks to all the physicians, healthcare associates, and patients who visited offices at Advocates for Arthritis and helped to begin the education process. This is a complex issue, but congressional offices seem to be interested and definitely need education. The ACR will continue to edify Congress and CMS on this issue, which is a key component to the sustainability of our livelihood and our subspecialty.
In continuing our dialogue, I recently met with CMS director Donald Berwick, MD, along with Audrey Uknis, MD, ACR treasurer, and Tim Laing, MD, chair of the Government Affairs Committee. We discussed consultation codes, payment reform options, and components of quality care. We emphasized the need for recognition for the extra time required to gain the expertise resulting from fellowship training and ongoing scholarship that is needed to diagnosis complex patients that could not be cared for by primary care physicians and the reimbursement commensurate with the extra work. One of our major concerns is that if the reimbursement does not match the expertise and extra work, then physicians will stop specializing in rheumatology—which will result in access-to-care issues for the aging population. CMS has started a vicious cycle that, if not stopped, could endanger many patients from receiving cost-effective care at the appropriate time purely based on access.
Help Us Reinstate Consultation Codes
Are you interested in educating your members of Congress on the need to reinstate consultation codes? Contact ACR advocacy staff or visit the ACR website to email your member of Congress (www.rheumatology.org/advocacy).
