Not only is Medicare reviewing payment for old codes, it has rejected reimbursement for new codes that can be used by psychiatrists. Last year, the RUC’s Chronic Care Coordination Workgroup (C3W) recommended that CMS pay physicians for the first time in 2012 for 4 non–face-to-face codes. Art Traugott, MD, a psychiatrist at the Carle Physician Group, Champaign-Urbana, Ill, chairs the C3W. The idea was to come up with new codes for specialists who mimic the kind of work that primary care physicians do. Traugott explained that psychiatrists and other specialists, such as cardiologists and rheumatologists, as well as primary care physicians could have used the codes, for example, to bill for a telephone encounter with a patient who called with a new problem. “The description of the codes was tightly written,” he stated. But in its final rule on the 2012 fee schedule, Medicare declined to reimburse for those codes.
The refusal to pay psychiatrists and other specialists for primary care–like service is especially worrisome as Medicare begins to transition to a “value-based” reimbursement system that emphasizes global payment and care coordination. That reimbursement system will be based on self-reported physician results to the Physician Quality Reporting System (PQRS)—the base version is already in place.
Kassaw explained that her psychiatry department at Baylor is not currently reporting to PQRS. “I could only find 2 measures that apply to psychiatry,” she explained. “Number 106 measures screening of patients with major depressive disorder for active symptoms and 107 measures screening of the same group for suicide risk.”
The lack of psychiatrist-related measures in the PQRS is particularly worrisome because the Affordable Care Act requires Medicare to establish a Physician Compare Web site no later than 2013 on the basis of physician reporting to PQRS in 2012. The CMS will come up with other measures as well, such as an assessment of a physician’s performance with regard to patient health outcomes and functional status of patient as well as continuity and coordination of care and care transitions. Physician scores will eventually be used in a value-based payment system.
The response of psychiatrists to Medicare’s continued inhospitability to psychiatrists in 2012 is cautious. Kassaw explained, “I have patients who ask me, ‘Are you going to continue to take Medicare?’ I say, ‘As long as I can.’ I no longer make any promises.”