Physicians in a variety of specialties spend considerable time consulting with patients on the identification and treatment of medical issues. In the case of neurology, for example, about 90 percent of all new outpatient visits are coded as “consultations.” If you’re a physician seeing someone for the first time who may have a complicated disease like MS or Alzheimer’s, clearly you’re going to spend an hour or more with them initially to determine the best course of action.

Now Medicare, in its infinite wisdom, has taken the chainsaw approach to cost cutting by eliminating consultation services as a benefit for all federally funded programs. Reduction in payment for existing consultation codes further devalues cognitive services (actually talking with and examining patients) and provides incentives for more physicians to look for ways to code things as interventions and procedures – one of the chief contributors to rising medical costs. In the words of one prominent Valley neurologist, “It is far easier for me to do a mindless procedure and get paid more than it is to do a consultation. We are definitely not going in the right direction for health care reform, and I increasingly fear for anyone with a difficult or rare medical condition.”

Ironically, the feds are interested in giving physicians $40K or more over multiple years to implement electronic health records, and then unilaterally devalue consultation services and potentially reduce the salaries of some physicians by $40K-$50K annually. It’s no wonder that many physicians take a dim view of Medicare “reform.”