Will any of you drop Medicare or restrict Medicare if pay cut goes through?

[myrandom2003]

As the title says, will any of you drop Medicare or restrict how many you see if the 9.x% pay cut goes through?

---

Members don't see this ad.

 

[jsaul]

As the title says, will any of you drop Medicare or restrict how many you see if the 9.x% pay cut goes through?

what will you replace it with? about 50 percent my patients are medicare. are you telling me you can drop 50 percent of your business and just at a drop of hat replace that 50 percent with all commerical insurances patients?

 

[callmeanesthesia]

what will you replace it with? about 50 percent my patients are medicare. are you telling me you can drop 50 percent of your business and just at a drop of hat replace that 50 percent with all commerical paying insurances?

Same. Medicare is 50-60% of my patients. And I think the other payors in my area index their reimbursement to Medicare to a degree, so they’d probably all drop too. Guess I’ll just have to look for ways to cut expenses or shuffle 10% more patients per day through…

 

[pmrmd]

We will be forced to be more efficient and look for ways to reduce expenses as much as possible. It won't be a great year.

 

[vit8bsm]

Absolutely ridiculous what they're doing. Healthcare costs are through the roof because of absurd facility fees hospitals charge, the behemoths are making the crazy money. Get a 50,000 surgery bill? Most of that is going to the hospital for bull**** to line corporate healthcare executives and admins pockets, meanwhile the cuts go to physicians.

I can understand regulation to improve healthcare costs and quality, but this is just absurd. They're slowly killing off physician owned practices.

No OP, I don't see how one can not accept medicare. So much of the population has it, and it's only going to cover more and more people as time goes on.

The reactions will probably include

1) Physician's trying to be more efficient in order to increase revenue to stay afloat and justify not going on salary to a hospital, seeing more pts and doing more procedures in a given time

2) more cash based stuff like regen and maybe cosmetics and other ancillaries

 

[geauxg8rs]

Absolutely ridiculous what they're doing. Healthcare costs are through the roof because of absurd facility fees hospitals charge, the behemoths are making the crazy money. Get a 50,000 surgery bill? Most of that is going to the hospital for bull**** to line corporate healthcare executives and admins pockets, meanwhile the cuts go to physicians.

I can understand regulation to improve healthcare costs and quality, but this is just absurd. They're slowly killing off physician owned practices.

No OP, I don't see how one can not accept medicare. So much of the population has it, and it's only going to cover more and more people as time goes on.

The reactions will probably include

1) Physician's trying to be more efficient in order to increase revenue to stay afloat and justify not going on salary to a hospital, seeing more pts and doing more procedures in a given time

2) more cash based stuff like regen and maybe cosmetics and other ancillaries

I am old enough to remember 2020 when we were “health care heroes” and signs that said “ our heroes wear scrubs.”

Actually worried about this when we spent like crazy in 2020 for Covid. I knew then that we were going to get cuts in pay. I just figured it would be a year or two later

 

[Dr. Ice]

When do we find out if this is going through?

 

[Yo GabbaPentin]

Just cram an extra 10% into your day. No big deal. Same the next year. And the next year. And the next year. We will all realize we are spending about 10 seconds with the patient, 10 mins putting all the BS in the EMR and seeing 60 patients per day to make 10% what the hospital admin makes. Can’t wait to answer questions about why I’m retired at 45.

 

[myrandom2003]

I think I will start charging for all medication prior auth
I already charge for FMLA/Parking forms. Maybe I will increase my fees by 10%

 

[drusso]

Definitely, time to opt-out. Without some juice from the SOS, you can be busy all day with government payors and still go broke. Focus on the better payers and higher-margin work.

 

[Dr. Ice]

Just cram an extra 10% into your day. No big deal. Same the next year. And the next year. And the next year. We will all realize we are spending about 10 seconds with the patient, 10 mins putting all the BS in the EMR and seeing 60 patients per day to make 10% what the hospital admin makes. Can’t wait to answer questions about why I’m retired at 45.

Retired at 45?! You must have a very nice back up plan..kudos to you. I’m 42 and figure I’ll work for another 25 years at least constantly re-inventing myself, unless crypto gets bigger I guess

 

[IAmTheOne1]

Do I just have really crappy contracts with PPOs? ... Medicare is almost always my best reimbursing payor

I have some HMOs that match Medicare 100% (without having to chase after 20% secondary). But PPOs almost never pay MORE than medicare. Do I (or can I) renegotiate my contracts with the PPOs? At the the very best the PPOs will pay 90% of medicare-ish and at worst some are paying like 60% of medicare rates.

So needless to say, dropping Medicare is not an option at least right now for me.....

 

[GoBeers]

I find HMO and IPAs are soooo much easier to deal with. everything is usually authorized so it's all straightforward. PPO is a piece of junk in my experience with crappy rates and deny everything.

 

[geauxg8rs]

We can always get a tip jar. When patients have sign their credit card receipt make sure the machine opts to only have options for 25% tip, 30%, or more. And have receptionist stare them down when selecting.

 

[myrandom2003]

Do I just have really crappy contracts with PPOs? ... Medicare is almost always my best reimbursing payor

I have some HMOs that match Medicare 100% (without having to chase after 20% secondary). But PPOs almost never pay MORE than medicare. Do I (or can I) renegotiate my contracts with the PPOs? At the the very best the PPOs will pay 90% of medicare-ish and at worst some are paying like 60% of medicare rates.

So needless to say, dropping Medicare is not an option at least right now for me.....

What is your nearest major metro area?
Middle of the country and south is usually better than Medicare except uhc

 

[ateria radicularis magna]

Retired at 45?! You must have a very nice back up plan..kudos to you. I’m 42 and figure I’ll work for another 25 years at least constantly re-inventing myself, unless crypto gets bigger I guess

What is your number? If your goal was to retire from medicine, your savings rate would need to be extremely low to require 25 years to get there.

 

[Iamnew2]

Do I just have really crappy contracts with PPOs? ... Medicare is almost always my best reimbursing payor

I have some HMOs that match Medicare 100% (without having to chase after 20% secondary). But PPOs almost never pay MORE than medicare. Do I (or can I) renegotiate my contracts with the PPOs? At the the very best the PPOs will pay 90% of medicare-ish and at worst some are paying like 60% of medicare rates.

So needless to say, dropping Medicare is not an option at least right now for me.....

You have some bad contracts then. PPO's/commercial reimburse significantly more than medicare. All of my commercials I t think pay far more than medicare.

 

[Dr. Ice]

What is your number? If your goal was to retire from medicine, your savings rate would need to be extremely low to require 25 years to get there.

Kids are a big variable..so is house. It I sold my house now id make a profit. In 10 years who knows

 

[promethius]

On a related note, has anyone noticed that Medicare has recently stopped reimbursing for the third level of facet joint injections? I noticed on a recent claim that CPT code 64495 is no longer covered. Any idea when this change took effect, and what the reason for it may be?

 

[Ferrismonk]

On a related note, has anyone noticed that Medicare has recently stopped reimbursing for the third level of facet joint injections? I noticed on a recent claim that CPT code 64495 is no longer covered. Any idea when this change took effect, and what the reason for it may be?

I believe that was in March.

 

[GoBeers]

You have some bad contracts then. PPO's/commercial reimburse significantly more than medicare. All of my commercials I t think pay far more than medicare.

probably because you're not working in SF, LA, NY

 

[vit8bsm]

probably because you're not working in SF, LA, NY

All my NYC MD friends make a lot more off private insurances than medicare, granted they got credentialed and have had contracts since like 2000, latest 2010

I agree that cali is def the worst place to be though, for medicine financially (unless doing cash stuff like plastics etc or you're some beverly hills renowned surgeon)

 

[Doctodd]

All my NYC MD friends make a lot more off private insurances than medicare, granted they got credentialed and have had contracts since like 2000, latest 2010

I agree that cali is def the worst place to be though, for medicine financially (unless doing cash stuff like plastics etc or you're some beverly hills renowned surgeon)

only if you survived the NY shutdown

 

[No_Pain_No_Gain]

On a related note, has anyone noticed that Medicare has recently stopped reimbursing for the third level of facet joint injections? I noticed on a recent claim that CPT code 64495 is no longer covered. Any idea when this change took effect, and what the reason for it may be?

This change took effect on April 25th, 2021. See link below for the full LCD.

There were a fair amount of changes to the LCD including but not limited to:
1) 2 weeks between MBBs
2) 80% relief requirement for MBBs
3) Maximum of 2 levels
4) 2 RFA sessions per rolling 12 months.

LCD - Facet Joint Interventions for Pain Management (L38765)

Use this page to view details for the Local Coverage Determination for Facet Joint Interventions for Pain Management.

www.cms.gov

 

[Iamnew2]

This change took effect on April 25th, 2021. See link below for the full LCD.

There were a fair amount of changes to the LCD including but not limited to:
1) 2 weeks between MBBs
2) 80% relief requirement for MBBs
3) Maximum of 2 levels
4) 2 RFA sessions per rolling 12 months.

LCD - Facet Joint Interventions for Pain Management (L38765)

Use this page to view details for the Local Coverage Determination for Facet Joint Interventions for Pain Management.

www.cms.gov

How is that so different? 80% relief and 2 weeks between MBBs has always been the standard. The max of 2 levels is different though. Same with 2 RFA/year essentially 2 per year.

 

[MD87]

Are privates asking for 80% also? I had thought it was 50%. Of course, patients will tell me they are 90% better and their pain is 9/10 or are 20% better and their pain is 8/10. or 10% better and they have no pain at all.

 

[soccrwz]

Are privates asking for 80% also? I had thought it was 50%. Of course, patients will tell me they are 90% better and their pain is 9/10 or are 20% better and their pain is 8/10. or 10% better and they have no pain at all.

Varies by plan

 

[drusso]

How is that so different? 80% relief and 2 weeks between MBBs has always been the standard. The max of 2 levels is different though. Same with 2 RFA/year essentially 2 per year.

Why two weeks before MBB's? Some rural patients drive 2 hours each way and it's inconvenient to wait 2 weeks. It's more efficient if they just stay overnight a couple of nights and do "block, block, burn" and get it all done in a couple of days. Easy-peezy.

 

[Iamnew2]

Why two weeks before MBB's? Some rural patients drive 2 hours each way and it's inconvenient to wait 2 weeks. It's more efficient if they just stay overnight a couple of nights and do "block, block, burn" and get it all done in a couple of days. Easy-peezy.

Are you serious or joking? I can't tell.

 

[drusso]

Are you serious or joking? I can't tell.

What's the science for 2 weeks?

 

[Iamnew2]

What's the science for 2 weeks?

Well that's standard protocol from my understanding, but the "science" from what I understand is that there needs to be reliable and consistent pain relief. So if you do back to back procedures that doesn't necessarily seem like there is much reliability and true long term pain relief.

 

[thecentral09]

It’s all BS from insurance and Medicare to make it more complicated for patients so they get frustrated with having to take more time off work, more travel time, and wait longer to get anything done so they hopefully don’t proceed with the whole process. Cheaper that way for the rule setters

What's the science for 2 weeks?

 

[Sig123]

Some good news. Ridiculous that they leave this to December of every year as practices potentially face this financial cliff.

"This approach would tie action on the debt ceiling to stave off nearly 10% in mandatory cuts to Medicare payments under the so-called Paygo law set to go into effect on Jan. 1. The pending cuts have alarmed hospital and doctors groups that say Medicare fee-for-service payments could be reduced by $14.1 billion in 2022 unless there’s action to stop them."

Bloomberg - Are you a robot?

 

[xvaderx]

It’s all BS from insurance and Medicare to make it more complicated for patients so they get frustrated with having to take more time off work, more travel time, and wait longer to get anything done so they hopefully don’t proceed with the whole process. Cheaper that way for the rule setters

What's the science for 2 weeks?

Some type of science that uses psychology and economics to write a cookbook.

 

[Multimodal]

Some good news. Ridiculous that they leave this to December of every year as practices potentially face this financial cliff.

"This approach would tie action on the debt ceiling to stave off nearly 10% in mandatory cuts to Medicare payments under the so-called Paygo law set to go into effect on Jan. 1. The pending cuts have alarmed hospital and doctors groups that say Medicare fee-for-service payments could be reduced by $14.1 billion in 2022 unless there’s action to stop them."

Bloomberg - Are you a robot?

Im reading that too. won tied the battle, and the war rages on. It looks like this problem will crop up all over next year when this extension expires. Also I still think there are cuts baked into the build back better plan so for our purposes, lets hope that doesnt pass too.

 

[drpainfree]

Retired at 45?! You must have a very nice back up plan..kudos to you. I’m 42 and figure I’ll work for another 25 years at least constantly re-inventing myself, unless crypto gets bigger I guess

BTC will get bigger, alt coins will be regulated and banned. so don't confuse BTC with the rest of garbage.

 

[powermd]

What's the science for 2 weeks?

It's in the psych literature under "learned helplessness".

 

[rexed]

On a related note, has anyone noticed that Medicare has recently stopped reimbursing for the third level of facet joint injections? I noticed on a recent claim that CPT code 64495 is no longer covered. Any idea when this change took effect, and what the reason for it may be?

I must have missed that boat, I was limiting to 2 levels max.

 

[powermd]

If the third level for MBBs/RF are no longer covered, I think that may be a blessing in disguise. It opens the possibility of offering a cash upsell on the procedure that could help offset all their other cuts. You could offer "a more complete procedure" for $250. In these days of rampant inflation and higher wages for everyone else - but us - I will certainly do this if it's legal.

 

[callmeanesthesia]

I must have missed that boat, I was limiting to 2 levels max.

You can still document necessity, appeal, and get the third level paid. I do it sparingly, when I feel it’s really indicated (extensive degenerative changes, prior success with 3 level RF or only partial relief with 2 level MBB, much better relief with third level). I had my billers audit the Medicare claims for the past year and it does seem like at least some of them are getting paid. I document in the procedure note for both the MBB and RFA that the third level is medically necessary because *reasons.*

 

[Ducttape]

i dont "do" 3 levels.

i have on 2 separate occasions done L34 and L5S1 and in 1 case did do L23 and L45.


technically that is 2 levels, but the net effect is that the procedure covers 3 levels.

 

[Ferrismonk]

i dont "do" 3 levels.

i have on 2 separate occasions done L34 and L5S1 and in 1 case did do L23 and L45.


technically that is 2 levels, but the net effect is that the procedure covers 3 levels.

You just are doing the same work for less money.

 

[RoloTomassi]

i dont "do" 3 levels.

i have on 2 separate occasions done L34 and L5S1 and in 1 case did do L23 and L45.


technically that is 2 levels, but the net effect is that the procedure covers 3 levels.

I've done this a couple times too but now that I think about it, why not just do 3, bill 3, and you at least get a chance of that 3rd level getting paid

 

[Dr. Ice]

I've done this a couple times too but now that I think about it, why not just do 3, bill 3, and you at least get a chance of that 3rd level getting paid

So people have routinely be doing L2, 3, 4 medial branch and L5 dorsal ramus/RFA and getting paid for it?

 

[Ferrismonk]

So people have routinely be doing L2, 3, 4 medial branch and L5 dorsal ramus/RFA and getting paid for it?

L2, L3 medial branch = L3/L4 Facet Joint
L4, L5 medial branch = L5/S1 Facet Joint

They are just billing 2 joints.

 

[paindoc007]

So people have routinely be doing L2, 3, 4 medial branch and L5 dorsal ramus/RFA and getting paid for it?

About 50% of the time I get paid for 3 facet levels where I live.

 

[Ducttape]

L2, L3 medial branch = L3/L4 Facet Joint
L4, L5 medial branch = L5/S1 Facet Joint

They are just billing 2 joints.

they are in effect treating 3 but billing for 2, and since there is no restrictions re "adjacent" or "consecutive" joints, it is "allowed".

 

[gaseous_clay]

they are in effect treating 3 but billing for 2, and since there is no restrictions re "adjacent" or "consecutive" joints, it is "allowed".

Like someone else mentioned earlier, you’re still burning 4 nerves but getting paid for 3. If you’re into freebies, then all is well.