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  • Chuck Hulse

What if I Am Wrong?

Humility is in the literature these days. As scholars write about healthcare, there is light being shined on the importance of leaders to demonstrate humility. And it is not just healthcare, we are in the era of adaptive change that requires us to figure out new ways to innovate. Leaders cannot do that alone, yet leadership requires strong opinions, strong convictions – hard to hold in check when the best idea may come from someone on the front line of patient care. Humility is a good thing - I am quite sure I am right about this.

What I may be wrong about is my thought that a one payer system would be a good thing. Seeing the chaos and complexity of multiple payers, multiple payment methodologies, different clinical standards - so much wasted energy by practices negotiating, monitoring, posturing, moving patients from one payer to another with the resulting negative impact on continuity of care moved me to think seriously about the single payer system lead by Medicare. Then comes proposed CMS physician payment reform – 2019.

I have reviewed the recent materials related to the simplification of payment for E&M services. The idea dates back over ten years, hence my first concern – does it really take that long to simplify something? Nonetheless the idea emerged through CMS to pay one rate, a blended rate, of the range of E&M codes. Good work I thought until I read on. For certain specialties, there will be a new code with a $12.00 bump in reimbursement… why? And[CH1] for services that may take more time (prolonged service) there would be a new add on code, and for higher complexity visits physicians would have yet another new code. In addition, the promise of reduced documentation to support the code will likely not happen for legal reasons.

CMS totally missed the mark with implementing pay for quality, not only with undo complexity, but then followed by not delivering on the promise of extra pay. And now we have an embarrassing attempt at simplifying the payment for ten or so of the 7,000 CPT codes.

I think I was wrong about single payer. Like MedMan and its support of private practice and entrepreneurial spirit, I am returning to the notion that private enterprise, private insurance may be a better direction. Then again, I may be wrong.

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