A Successful Reformed Health Care System Requires A Balance of Physicians
Primary care physicians are an essential component to any health care system. Equally important are specialists. However, the current state of health care reform devalues the importance of certain types of specialists – cognitive specialists. Cognitive specialists primarily perform evaluation and management services to diagnose and treat complex, chronic and debilitating diseases, such as rheumatoid arthritis and lupus. These physicians are lumped in with surgical/procedural specialists and therefore, ignored by the system. A successful health care system must have primary care physicians to handle coordination of care and routine issues as well as refer complex, chronic diseases to appropriate specialists who have the expertise and additional training to manage those diseases.
Devaluing Specialty Care Could Lead To The Loss of Cognitive Specialists
Rheumatologists, endocrinologists, infectious disease physicians, and neurologists are all cognitive specialists. These physician specialists have expertise in a single area of medicine. They obtain the specialty designation by continuing their medical education for an additional two to three years, and this additional training prepares them to handle complex diseases and determine best treatment options.
Recent Policy Changes Devalue Specialty Care
While cognitive specialists are valued by patients, they are clearly undervalued by the Centers for Medicare and Medicaid Services, which was made clear in 2010 when CMS eliminated consultation service codes used to recognize the services of a specialist. This policy change fails to acknowledge specialty expertise and the detailed work that is performed in a consultation – thereby deterring medical students from pursuing training in rheumatology and other cognitive specialties. This kind of devaluation could result in a drastic reduction of the nation’s ability to meet future health care needs – especially in the diagnosis and treatment of complex, chronic conditions.
Rheumatology workforce and training surveys forecast extreme shortages over the next 20 years, which is of particular concern considering nearly 50 million Americans suffer from arthritis and rheumatic diseases, and many more will be added to this number as baby boomers continue to age.
Unfair Incentives Send a Strong Message and Threaten Patient Care
While Congress took a step in the right direction with the Affordable Care Act, it sent a strong message: primary care physicians and physicians who perform procedures are valued; cognitive specialists are not. The Affordable Care Act provides a 10 percent payment bonus to designated primary care physicians to improve their workforce. And, when this bonus is combined with Medicare’s current consultations policy, cognitive specialists are now reimbursed less than primary care physicians — even when performing the same E&M services — despite the fact that their patients’ conditions are often chronic, severe, and difficult to diagnose and treat.
This skewed reimbursement model provides no incentives to pursue rheumatology and other cognitive specialties. Without an adequate and fair payment system and a balanced physician workforce, patients will be unable to access necessary and appropriate, high-quality, cost-effective health care.
The Solution: Equality in Reimbursement
The ACR requests Congress to adequately reimburse cognitive specialists who care for patients with complex medical conditions that require a level of expertise, which is beyond the training of the primary care physician.
The ACR also requests Congress require CMS to accept a payment add-on code that recognizes the value of specialty care for patients with complex medical conditions in care coordination, better outcomes and cost savings in the health care system.
