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The intent behind a new federal proposal to flatten physician reimbursement for office visits is admirable, but the plan could also have harmful side effects and unintended consequences for many patients and physicians.
This is the central argument in a commentary penned by health care economist Zirui Song, assistant professor of health care policy at Harvard Medical School, and John Goodson, associate professor of medicine at Harvard Medical School, both of whom are also primary care physicians at Massachusetts General Hospital.
The plan—intended to reduce administrative burden among doctors—would allow for payment of a flat fee for office visits to physicians who care for Medicare patients regardless of the severity and complexity of their condition, or the time physicians spend seeing them.
Under the proposal, physicians would receive the same reimbursement whether they see a patient for a sprained ankle or seasonal allergy or for cancer, lupus or heart failure.
In a Perspective article for the Aug. 16 issue of The New England Journal of Medicine, the authors argue that the proposal would threaten Medicare patients with complex conditions by creating incentives for shorter and more frequent visits.
Long-term, the approach could also exacerbate physician shortages in certain specialties that generate most of their revenue through complex office visits requiring higher cognitive intensity and nuanced decision making—those visits would effectively receive a fee cut. In contrast, the plan would increase office visit revenue for specialties that bill for short or single-problem visits.
The promise of reducing administrative burden on physicians may be a mirage, at least for some specialties and in certain cases. This is because physicians who treat the most complex cases would still need to find a way to explain and justify their nuanced decision making and clinical rationale for certain therapies, the authors point out.
Policymakers, the authors conclude, should consider alternative strategies to reduce documentation burden while maintaining the incentive to take on patients with complex medical needs. In so doing, they would also protect medical specialties that depend on complex office visits as a chief source of income.
The ultimate goal of any effort to reduce administrative burden on physicians, the authors say, should be to do so by rewarding effort and, above all, by ensuring that all patients receive the attention, care and treatment their specific condition calls for.
