Time Is Money? Not For Docs.

Treating older patients with chronic conditions requires more than face-to-face visits in the doctor’s office. But much of this additional care — including the time doctors spend talking to families, ordering medicine and consulting with other physicians — is not reimbursed by Medicare, according to a small study in last month’s Annals of Internal Medicine.

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The study of 16 geriatric physicians at the Mount Sinai School of Medicine in New York found that for every 30 minutes doctors spent seeing patients, they spent an average of more than six additional minutes providing uncompensated care. The researchers estimated that a doctor with a full-time schedule of office visits would put in almost eight additional hours for which he would not be paid every week.

“A lot of time I spend doing the important work is happening behind the scenes, not face to face,” said Jeffrey Farber, one of the report’s authors and an assistant professor at Mount Sinai’s department of geriatrics and adult development.

Farber cited a patient who came to him with severe headaches. “The meat of the work” came after the visit, Farber said, in talking to the patient’s family about medical history and coordinating a treatment plan with other physicians. Under Medicare’s reimbursement plan, Farber said, he received no payment for this “under the radar” work.

Herb Kuhn, deputy administrator at the Centers for Medicare and Medicaid Services, said the findings were based on a false assumption. “Pre- and post-service work beyond the face-to-face work are all services that are already bundled into payments for physicians,” he said.

That understanding isn’t shared by Silver Spring geriatric specialist Burt Feldman, president of the local affiliate of the American Geriatrics Society, who said most other insurers also reimburse doctors for face-to-face visits only.

“I try to do as much of my care as possible face to face,” said Feldman, who was not involved in the study. He said he spends about three hours a week providing care for which he isn’t paid — coordinating test results, renewing prescriptions, etc.

Feldman said pediatricians and doctors who treat patients of any age for chronic conditions face the same issue, but he has no plans to cut back on this extra care.

“I could not possibly do my job adequately if I did not do the non-face-to-face” work, he said.
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