AMA forwards physician concerns about burdensome federal regulations to CMS

A significant percentage of American Medical Association members have identified federal regulations they consider burdensome and inefficient, according to a press release from the organization.

President Barack Obama issued an executive order in January calling for government agencies to reduce federal regulatory burdens.

In response to the order, the American Medical association (AMA) conducted a survey asking member physicians and medical societies to identify problematic regulations and suggest ways to improve them. More than 2,000 physicians responded to the survey, according to the release.

Areas of concern

On April 13, Michael D. Maves, MD, MBA, executive vice president and CEO of the AMA, summarized members’ concerns in a letter to Donald Berwick, MD, administrator of the Centers for Medicare & Medicaid Services (CMS).

Cecil B. Wilson

“Thousands of physicians have answered the AMA’s call to identify federal rules and regulations that create significant burden for their practices and take up time that is better spent with patients,” AMA president Cecil B. Wilson, MD, stated in the release. “Physicians’ top concerns, including unfunded federal mandates, elimination of Medicare payment for physician consultations, and incompatible and inconsistent quality initiatives, offer a road map for CMS to make strategic changes that benefit the entire Medicare system.”

Survey responses

As noted in the letter, 60% of responding physicians cited unfunded mandates such as translators for Medicare and Medicaid patients, preauthorization of prescription drugs covered by Medicare, financial and legal liability for poor or uninsured patients, and documentation and certification requirements.

Forty-eight percent of respondents voiced concern about CMS prohibiting the use of consultation codes in Medicare and requiring physicians to bill for those services with lower-valued codes, according to the letter.

Other areas of concern included incompatible incentive programs, inconsistent audit policies and Medicare enrollment delays.

The AMA called for CMS to increase education efforts for physicians, re-instate consultation codes, align quality measures, reduce reporting burdens on physicians and target providers who violate regulations.

EMR, payment cuts

William R. Beach, MD, a member of the Arthroscopy Association of North America board of directors and Orthopedics Today editorial board member, highlighted the lack of clarity regarding regulations and noted that the elimination of the consultation codes by CMS was offset by additional payments for new and established patients.

“AAOS [American Academy of Orthopaedic Surgeons] staff calculated that if you coded consultation visits, less than one out of every six patients, elimination of the consultation codes was financially beneficial,” he told Orthopedics Today.

He added, “The inconsistency and lack of clarification on subjects, such as meaningful use for electronic medical records [EMR] and the difficulty of achieving the current requirements, makes conversion to EMR frustrating and unclear. We encourage CMS to consider the expense and difficulty in implementation of many of its rules and to simplify these requirements when possible.”

Orthopedics Today Chief Medical Editor Douglas W. Jackson, MD, said that while the burdensome federal regulations from CMS are “irritating,” they are secondary in importance to the scheduled Medicare physician payment cuts.

“During those periods recently when Medicare withheld payments while delays in reimbursement cuts were being considered by Congress, it impacted our cash flow,” Jackson told Orthopedics Today. “It was an interest-free loan, and we still had to meet our ongoing expenses. The federal regulations will be even more intolerable if the scheduled reimbursement cuts go in effect after the election of 2012. Very few private practitioners will be able to participate and meet their overhead if they do. The additional paperwork and denials just are irritants on top.” – by Gina Brockenbrough

Reference:

• www.ama-assn.org

• William R. Beach, MD, can be reached at Tuckahoe Orthopedics, PO Box 71690 Richmond, VA 23255; 804-285-2300; email: beach@orv.com.
• Douglas W. Jackson, MD, can be reached at Orthopedics Today, 6900 Grove Road, Thorofare, NJ 08086; email: OT@slackinc.com.

Jack M. Bert

There is no question that physicians are very concerned about Medicare reimbursement rates, and that many older physicians that I know are planning to opt out of Medicare as reimbursements continue to decrease. Unfortunately, private insurers tend to follow Medicare reimbursement guidelines because they know they can get away with it, citing Medicare reimbursements as “federally recommended”.

Except in a couple of states, physicians cannot unionize or collectively bargain to fight these changes, so we tend to passively accept these reimbursement changes, which are terribly destructive to our clinical practices. I would urge all orthopedists to call and/or write your local and federal legislators and urge them to look carefully where the real costs of medicine are occurring.

Physician reimbursements compromise less than 15% of the cost of medical care. The remainder is “hard costs” which continue to increase every year as our reimbursements continue to decrease. We should not be punished for our minor role in the economics of medical care which is to give high quality patient care.

— Jack M. Bert, MD
Orthopedics Today Business of Orthopedics Section Editor
Summit Orthopedics, Saint Paul, MN