My aversion to faxes might be traced to fact that they serve as the primary mode of delivery for the dreaded prior authorization forms required for a growing list of drugs.
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Explore This IssueApril 2013
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New Rules: Sometimes It’s Just Better To Leave Well Enough Alone
The late Robert K. Merton (1910–2003) was a distinguished sociologist who spent most of his career working at Columbia University in New York City. He is best remembered for his contributions to the nascent field of the sociology of science. Among the notable concepts that Merton developed are the ideas of self-fulfilling prophecies and the description of the unanticipated consequences of social action. The latter phenomenon best describes the outcome of a recent income redistribution experiment gone awry.
In 2010, the Centers for Medicare and Medicaid Services (CMS) instituted a targeted policy to redistribute Medicare payments from specialists to primary care physicians (PCPs) in a supposedly budget-neutral manner. Specifically, CMS eliminated payments for the higher-compensated consultations from the Medicare Physician Fee Schedule, which were billed more frequently by specialists, and raised the fees for office visits, which were billed more frequently by PCPs. New office visits (such as codes 99203 and 99204) largely replaced consultations (codes 99243 and 99244). Since each office visit charge was reimbursed at a lower rate than the corresponding consultation charge, the expectation was that the redistribution of payments would result in a net loss of income for specialists, even though the payment for office charges was raised slightly. Paradoxically, Medicare ended up spending an average of $10.20 more per beneficiary per quarter for all physician encounters, a 6.5% increase.5 Why? The total volume of physician encounters did not significantly change. Instead, the increase in spending was largely explained by the higher office-visit fees set by this new policy and especially because of a shift toward higher-complexity visits that were billed more frequently by specialists and PCPs. Paradoxically, the elimination of the more costly consultation codes resulted in a net increase in spending on visits to both PCPs and specialists. When it comes to medical economics, you don’t need to be a Nobel Prize–winning economist like Robert C. Merton, the son of Robert G. Merton, to devise strategies to offset a possible loss of income.
New Rule: Let’s Pretend We Are Actually Working in the 21st Century
Sending out a prescription requires most of us to travel back in time. Specifically, back to the 1980s, when cordless phones were still cool (watch any Seinfeld episode) and the idea of the Internet was just a thought percolating through the mind of Al Gore. Faxes ruled the business world; after all, they were considered a marvelous invention for the time. Computer technology was still in its infancy. For example, in 1980, an IBM mainframe computer with 20 gigabytes memory weighed more than two tons and cost over $700,000. Today, most standard laptops cost under $1,000, weigh about three pounds, and offer at least 500 gigabytes of memory.