My point is that just because a payer happens to be a relatively poor one, the government, which now expects more value for its money, doesn't mean you necessarily get to break down your responsibility to provide quality patient care into tinier and tinier bits so that each step in the process is reimbursable.
If you can't make a decent living servicing these patients under the reimbursement system that is currently in place, why not lobby for an overall increase in reimbursement, or better yet, just stop taking new Medicare patients? (My understanding, anecdotally, is that this is happening at a higher and higher rate. Dropping Medicare patients instead of arguing for reimbursement for things that most patients feel you should be doing anyway should eventually solve the problem as seniors, who vote, complain to their legislators). But let's not pretend that the reason healthcare has a big hand in bankrupting us all is because we haven't thrown enough money at it or broken it down into smaller and smaller reimbursable steps.
Look, I'm not suggesting that extra work doesn't go into caring for Medicare beneficiaries who have multiple illnesses. They are a difficult group, and it's OK that the AMA and its members are asking and lobbying for extra payment, but geez, can you imagine the way a system like this could be gamed?
I could be wrong, but I doubt a plea like this will fall on willing eyes and ears at CMS, which is actively discouraging fragmentation of healthcare, not abetting it.
Can't we all agree that fee-for-service healthcare reimbursement is a failure in the sense that patients aren't best served by piecemeal delivery and lack of care coordination? And shouldn't we all agree that once and for all, patient care shouldn't stop at the office door? The whole thing makes my head spin and long for capitation, as many problems as that created.