Full-time physicians spend an average of one full day a week providing services for patients that are not reimbursed by Medicare, according to a new study conducted by Jeffrey Farber, MD, Assistant Professor of Geriatrics at The Mount Sinai Medical Center, and published the journal Annals of Internal Medicine.
The study results could potentially prod insurance companies and Medicare to catch up to physicians' current levels of productivity by reimbursing them for the care that is increasingly taking place outside of formal office visits.
“These services that are going un-reimbursed are not unusual or luxury services,” explained Dr. Farber. “These are basic elements of good patient care and include such things as talking with adult children, managing pain over the telephone, calling pharmacies, coordinating home care services like physical therapy and visiting nurses, and ordering equipment like canes and wheelchairs.”
In 1965, when Medicare was first established, elderly and even middle-aged patients often died from their first heart attacks, strokes, or bouts with cancer. However, today, diseases that were once considered acute are now treated as chronic conditions, and geriatricians are spending more of their time helping these patients treat long-term, but manageable medical problems.
In 2006, people aged 65 and older represented 37.3 million of the U.S. population, according to the U.S. Department of Health and Human Services. That figure is expected to double to 71.5 million by 2030. While the need for physicians specializing in the care of older adults grows, the number of medical students entering the fields of geriatrics and primary care is declining, says Dr. Farber.
“Primary care physicians are finding it increasingly difficult to practice the kind of medicine that their patients need,” Dr. Farber explains. “Our findings illustrate the inequities that exist in the current reimbursement system and the barriers that exist to promoting good medical care for older adults.”
To measure how much time doctors worked outside of formal office visits, Dr. Farber and his colleagues Albert Siu, MD, the Ellen and Howard Katz Professor of Geriatrics and Chairman of the Brookdale Department of Geriatrics and Adult Development, and Patricia Bloom, MD, Associate Professor of Geriatrics and Adult Development, designed a form to document interactions with patients, including the type of interaction, how much time they'd spent, what it was about (a medication refill, family counseling, pharmaceutical pre-approval, or other task) and the outcome of the interaction, such scheduling an appointment, referring the patient to a specialist, or changing the type or dose of a medication.
Doctors in the study all worked at the Coffey Geriatrics Practice at Mount Sinai. The researchers collected data from 16 doctors, documenting 472 separate interactions with patients ranging from 67 to 101 years old.
The study showed that the average episode of non-reimbursed care lasted just 10 minutes, but they happened often enough to add up to 7.8 hours every week. A full 36 percent of the interactions involving a new medical symptom resulted in either a new prescription or a change of medication. Twenty-seven percent resulted in an office visit that had not been previously scheduled. “These are real medical decisions being made, and all of this work is not captured in the current reimbursement system,” Dr. Farber says.