The American Medical Association wants the Centers for Medicare & Medicaid Services to start paying doctors extra for care coordination. The group argues in a letter to CMS administrator Donald Berwick that four types of care coordination services should be reimbursed separately from the office visit to ensure physicians are compensated for providing these services.
Before I criticize their position, I want to note that their argument, on its face, is sound. Care coordination, in many cases, does prevent more expensive hospital care down the road. That's because, in theory, patients aren't made sicker because of poor communication among their various doctors, usually one or more specialists in addition to a primary care physician.
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The idea is to get all the providers actually communicating with each other instead of each operating within their own silos, thereby possibly endangering the patient with incompatible drugs, treatments, or conflicting advice.
And taking care of these kinds of patients is more difficult and time consuming than treating healthier ones, while both are reimbursed at the same rate. But that's where my agreement with their position ends.
Excuse me, but as physicians sworn to do no harm, isn't this kind of work what they should be doing already? The presupposition in their argument is that physicians' responsibility for overall quality patient care begins and ends at coding.
To take their argument further, perhaps they should be reimbursed separately for writing a prescription when the patient is not in the room? The fact that many physicians don't currently coordinate care is just one indication of why our national healthcare bill is frighteningly large and rapidly growing larger. Of course, patients have some responsibility for coordinating their own care, but clearly, most don't have the ability to do this job on their own.