Tuesday, June 02, 2015

Money coming in through the back door?

Robert Pear at the New York Times offers an excellent summary of findings by the General Accountability Office that the procedure used by the Medicare agency (CMS) to determine the relative weightings for $70 billion physician payments has major flaws.  That CMS weighting is also used by most private insurance companies as the basis for physician payments.  This is a topic that has received coverage over the years, but little has changed.

(A pause here to ask and refer back to a previous post:  When was the last time you heard one of the Triple Aim advocates—inside or outside of CMS--take on this issue, which has a direct result in how much primary care doctors and other cognitive specialists get paid?)

But, there is an important reminder in this story.  Pear notes (with my emphasis added):

“Under federal law, Medicare fees are supposed to reflect the time required to perform a service and the intensity of the work.”

Uh oh.  Let’s consider how the pervasive use of robotic surgery will factor into this calculation.  For example, in the past, most prostatectomies would have been done as open procedures or using a manual laparoscopic approach.

Now, due to a highly successful marketing campaign by Intuitive Surgical and by doctors and hospitals that have showcased their robotic surgery program, the vast majority of these cases are performed robotically.  This has increased the required time in the operating rooms.

The same applies to other procedures in which Intuitive has made and will make inroads—gall bladder removal, hysterectomies, hernia repairs, and so on.

Is this a back-door way for surgeons to receive more money for the same procedures?


Gary Levin said...

From G+:

It's more like no door at all.

Anonymous said...

I'd have to agree with Gary Levin. The constant asking for money is because the govt. is not stopping the business juggernaut.