Home Hemo
Joined: 23 Jun 2003
Posts: 22
Posted: Wed Oct 22, 2003 10:02 am Post subject: New Policy from CMS?
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I was told yesterday by the dialysis center that handles my home hemo, that CMS has instituted a new policy that nephrologists will have to visit their patients, while on dialysis, once a week. This is the "
ainchild" of Thomas Sculley, and is supposed to go into effect after the first of the year. If this happens, I can see many nephrologists leaving the profession. I can also see all home patients forced back into centers, centers becoming very large, and small centers closing so doctors can see as many patients as possible. It's obvious that doctors won't be seeing patients at home. At any rate, I don't know if this is a rumor or not, but coming from the dialysis center, I feel there may be some truth to it. Have any of you heard anything about this? I sent messages out today to my Congressional members to see if they know anything. I would much rather see my doctor once every 2 months than have to go back to a center to see him, where if I were lucky, I'd see him for all of 1 or 2 minutes. If anyone knows anything about this, please post it. Thanks a bunch!
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leadsag
Joined: 31 Oct 2002
Posts: 263
Posted: Wed Oct 22, 2003 11:31 am Post subject: doctor visit
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If I recall correctly, what was changed is the doctor would have to see the patient 4 times a month in order to keep his fee(reimbursement) at the same level he is currently receiving. If he were to see each patient less times he would just not receive as much money as he currently was receiving.
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FYI
Joined: 15 Feb 2003
Posts: 72
Posted: Wed Oct 22, 2003 2:24 pm Post subject: CMS Policy
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When we were up in Baltimore Maryland, we were called the next day on this. It doesnt mean they have to come to your home. <
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>As it stands now the Nephrologist has never had to see a patient. They automatically got anywhere from the going rate of $500.00 - $700.00 a month seperate from the composite rate to acknowledge his/her patients were still alive. No progress notes ever had to be kept, nor did they have to see you as a patient. The nurses, etc would and could just get verbal orders,no accountability from the physician.<
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>Now CMS is going to ensure that the physicians simply see their patients and not automatically get paid to do nothing. I think this is one reason the industry has been so poor with quality of care issues.<
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>This in no way should affect home hemo patients in a negative way. Patients, for once will have the physicians back in ordering care and accountable. If anything you will have at least a physician taking control of your treatments. Visit you at home....dont think that will happen. You will at least have contact with your physician either phone or if you go into the office.<
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>This is one option, plus having the patients rate the care they receive. This I have trouble with. A patient needs to have proper education in order to know that it is more than a nurse smiling and coffee, meanwhile you receive "jiffy lube" poor treatment. Also it needs to go to a neutral enity to compile the surveys. As it is now no one is safe when the gatherers are the industry that spoon feeds CMS with honorary data collection.<
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>At least CMS is making some changes, but still need to do what is right by you the patient.<
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>Arlene
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Lin
Joined: 28 Oct 2002
Posts: 337
Posted: Wed Oct 22, 2003 11:52 pm Post subject: Neph visits
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I've been on dialysis for over two years and my neph. has never visited me at the unit until last week. I all but fell throught the floor. I've been on private ins. but will soon be Medicare primary. I'm wonder now if the new regs. spurred the visit from neph.. Normally I have to make appt. to see him in office, and have appt. next week anyway. Lin.
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Bill Peckham
Joined: 06 Jan 2003
Posts: 65
Posted: Thu Oct 23, 2003 4:24 am Post subject: CMS Rule Change
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You're right HH, this rule change, if it goes forward without change, will negatively impact home dialysis, both PD and Hemo. As Leadsag wrote, currently under Medicare Docs get a flat fee in the $270 range per month, under the proposed rule change Docs would be paid per visit but the amount reimbursed would jump significantly from two or three visits a month to four visits. The rate for 3 visits would be reimbursed on the order of $130 while the rate for four visits would be in the $300 range.<
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>There is no language in the proposed rule change about home patients. The rule change does not mention the impact this rule change would have on patients that work and dialyze on the night shift. There is no language to address geographically dispersed patient populations or geographically isolated patients. There is no acknowledgement that an office visit has a much greater value than a wave-by unit visit. There is no language describing what constitutes a visit ? a phone call, a five minute chat, eye contact ? or what. <
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>The model this law would reward is the model where a Nephrologists is affiliated with a single unit. The model where all the patients a Nephrologists sees must dialyze at the unit where his office is located. The Nephrologists and unit are a package deal, if a patient wants to change units they must also switch Nephrologists. In other words, the model that Scully is most familiar with but it is also the model that is not the most patient friendly or progressive. In the Seattle area you can see any Nephrologists and dialyze at any unit and switch one while keeping the other. The Docs out here have patients scattered across the region and I can tell you that there is no way - zero, nada, zilch chance - that any doc could see each of their patients once a week during treatment. Out in Seattle a doc could have patients dialyzing on six shifts at twelve different units scattered across the twelfth largest county, geographically, in the United States. Not to mention patients in Port Angeles, a three hour car and ferry trip from Seattle. There are no Nephrologists in Port Angeles, all Port Angeles dialysis patients must travel to Seattle once a month to see their doc, with this rule change a doc would get about thirty dollars a month to follow a Port Angeles patient.<
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>The rule change also does not recognize that our Nephrologists are our primary physicians. There are many medical issues that I would not be comfortable discussing in an unit ? the majority in fact ? many that have nothing to do with dialysis. The idea that the care provided by a doc that walks by once a week, waves, asks how ya doin?, signs a slip of paper and then moves on, the idea that this is of more value than a doc that sees you in his office for ten to twenty minutes once a month makes no sense. This is a bad rule change. It rewards jiffy lube care at the expense of individualized care. There is a path to reach the goals of this rule change - better, more in touch care by docs - but this is not what is needed.<
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Disgusted
Joined: 26 Jan 2003
Posts: 45
Posted: Thu Oct 23, 2003 4:29 am Post subject: Neph visit's
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A nephrologist should be making rounds in the clinic once a month. And this new reg should help with this. I have not seen my neph "in the clinic" in over a year. I do not mind driving to the city if I am not sick. But to not make rounds when the patients are ill is another situation. The larger providers think this is a mighty fine arrangement to use the telephone for all orders from the nephrologist but to have a nurse tell me that she has never even seen what my doctor looks like is absolutely shameful.
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FYI
Joined: 15 Feb 2003
Posts: 72
Posted: Thu Oct 23, 2003 5:15 am Post subject: Negative Impact?
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I personally feel that many of the Nephs have had a free ride. They have been allowed to get away without ever seeing, visiting their patients. Now they are forced to. I dont see where that has any negative impact.<
>As it stands now, a physician does not even have to do any progress notes and are paid for not doing their jobs. I feel that this was wrong. I would love to get thr $500-$700.00 a month besides the composite rate for doing nothing and not even taking care of your patients.<
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>As far as home hemo, it will not have any negative impact on home patients. If so how? I feel that this is another scare tactic of the industry to help the patients fight for getting it back to where they do nothing. I personally am not a patient, but would feel more secure if I knew that my doctor had to physically do something,and not to have RN's become my doctor. This is only I feel a way to make the physicians accountable. this industry has never been patient friendly.<
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>It was and is my understanding that this in no way it will impact home hemo. If it does, then we need to ensure that it truly wont. Home hemo is an option that should be available.<
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>I must be missing the picture. How is the fact that the physician must see you, impact your care.<
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Curious
Joined: 02 Feb 2003
Posts: 39
Posted: Thu Oct 23, 2003 5:18 am Post subject: Drs make $500-$700 dollars a month
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per patient. That does not appear to be chump change by my standards. That is worth a trip a month.
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Bill Peckham
Joined: 06 Jan 2003
Posts: 65
Posted: Thu Oct 23, 2003 5:32 am Post subject: One trip = $30
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This rule speaks to Medicare reimbursement which varies by geographic location but is currently in the $270 range per patient, per month. The change means that in order to keep the same revenue per patient the doc would have to see the patient four times a month or once a week. If the doc saw their Medicare patients once a month the doc would recieve about thirty dollars a month per a patient.<
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>For background check this link to the AAKP's letter to CMS in regard to the rule change:<
>www.aakp.org/Washington_Update_PP.htm
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Bill Peckham
Joined: 06 Jan 2003
Posts: 65
Posted: Thu Oct 23, 2003 6:14 am Post subject: CMS rule change
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Source - Federal Register: August 15, 2003 (Volume 68, Number 15 :<
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>"...To align the payment incentives with the frequency of the physician personally evaluating the dialysis patient, we are proposing to make CPT codes 90918, 90919, 90920, 90921 invalid for Medicare and to create <
>G codes. We are proposing to create 3 new G codes in place of each CPT code with higher payments associated with providing more visits within each month to an ESRD patient. Under our proposal, there will be <
>separate codes when the physician provides 1 visit per month, 2-3 visits per month and 4 or more visits per month. The code for 1 visit per month will have the lowest payment while a higher payment will be <
>provided for 2 to 3 visits per month and the highest payment for 4 or more visits per month. Our methodology for determining payment is described below. These new codes will be reported once per month for services performed in an outpatient setting and related to the patient's ESRD. These physician services will continue to include the establishment of a dialyzing cycle, outpatient evaluation and management of the dialysis visits, telephone calls, and patient management, provided during a full month. These codes would not be used if a hospitalization occurred during the month..."<
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>The actual language for each relevant code follows:<
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>"...GXX14--End Stage Renal Disease (ESRD) related services per full month, for patients 20 years of age and over; with 4 or more face-to-face physician visits per month.<
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>GXX15--End Stage Renal Disease (ESRD) related services per full month, for patients 20 years of age and over; with 2 or 3 face-to-face physician visits per month.<
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>GXX16--End Stage Renal Disease (ESRD) related services per full month, for patients 20 years of age and over; with 1 face-to-face physician visit per month.<
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>There is nothing about Home dialysis - Hemo or PD - in the language as published in the Federal Register. There will be a great disincentive to have home patients if you only get reimbursed for one visit per a month and I don't see how home patients could see their doc more frequently than once a month. Also the other concerns I posted are real and serious - What about Geographically dispersed patients and geographically isolated patients? What about patient privacey? This rule change is seriously flawed.<
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