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.


Anonymous said...

Those payments are real eye openers. How does Medicare expect Doctors to work for that amount? Where is all the money going? I think when the economics are this confusing, there is a reason. Keep 'em in the dark and tax the hell out of them.

Anonymous said...

So, counsel someone for 10 minutes and 1 second, thats $140/Hr, or $280,000/Yr assuming a 40 hour week and 2 weeks vacation.

Healthnut said...

WSJ just came out with a story, "Bid to Halt Medi-Cal Cuts Rejected".

(should all be on one line)

Are people humans anymore?

Anonymous said...

Medical counseling on health issues from an MD should be higher reimbursed like some insurances cover a psychiatrist or psychologist counseling.
If someone has a doctor that is interested, cares and there is a comfortable connection with trust and a motivated patient it can really help to change or prevent more serious expensive health risks and disease out comes in the future. When things are explained well and not rushed it can make a huge difference.

Toni Brayer MD said...

frank drackman: Medicare only pays for one code per visit so it is either $11.96 or $23.55. Since a primary care physician running a very tight ship (which few can do) has 50% overhead expenses...the math equals about $942/week or $47,100/year. That is, of course, including your very generous 2 week vacation.

Anonymous said...

50% over head to run a medical practice is very high, I think most people don't realize it is that high.

Dr. Know said...

Anon 9:24: Actually the days of 50% overhead are probably long over. Now it's 60% or even more.

Anonymous said...

I think physicians and everyone should have more then two weeks of vacation.
When you think of the years of intense medical school and training, and before hospitalists years of being on call and making rounds.
I'm not a doctor but have wokred with many. For years they would have to take turns on nights and weekends being on call.

In Europe everyong gets about six weeks of vacation to enjoy some quality of life, travel, experiance new things,relax with family and friends to get rejuvinated.

Anonymous said...

I'm a primary care doctor. Personally, I don't JUST counsel a patient regarding smoking cessation during an office visit; I tack the counselling fee on to whatever else I saw them for that day. It is something we should be doing anyway, and it is nice to see Medicare pay SOMETHING for it, even if it isn't much.

And yes, the days of 50% overhead are long over, mostly thanks to Medicare rules for reimbursement, which make it so I have to hire experts just to bill them correctly and get what's coming to me.

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