Wednesday, July 30, 2008
What "Patient Counseling" is Worth
Effective Jan 1, 2008, there are two codes that doctors can use for "Smoking and tobacco use cessation counseling visit: intermediate, up to ten minutes (99406)" and "greater than 10 minutes (99407)". The reimbursement for 99406 is $11.96 and for 99407 it is $23.55.
(Yes, you saw those numbers correctly. I can't wait to get my check for $11.96)
Welcome to the world of Primary Care.
Smoking is one of the most detrimental of bad health habits and it costs each American $630 a year in federal and state taxes for the public health of smoking related problems. A pack of cigarettes costs $4.49 and a 40-year-old who quits smoking and puts the savings into a 401(k) earning 9% a year would have nearly $250,000 by age 70. So how much is primary care counseling really worth to society?
Why is something that should be valued...helping patients quit smoking...reimbursed pennies, yet a CT of the lung to check for cancer can be reimbursed over $2,000.00. Add on pulmonary consults, PET scans, follow up CTs, and Chest X-rays to evaluate a lung nodule and you can be up to $25,000 in no time at all. That is all just "screening"...not even a diagnosis or treatment.
What does this tell us? Primary care is dead in the United States and our health system is imploding with misaligned incentives and payments. The $11.96 that Medicare pays a primary care physician will buy 2 packs of cigarettes with change left over for a donut.
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