Ground Floor Theatre
Patient Problems Pile Up
RECEIVED Tue., Oct. 10, 2023
Dear Editor,
Dr. Nancy Binford is right that higher payments to hospital-based practices than to community-based practices are a big problem. [“Opinion: Patients Shouldn't Be Charged More by Hospital-Owned Practices than Physician-Owned Practices,” Oct. 6] And, there's also another problem with differential payment based on location.
Physicians are not able to charge the same amount to Medicare for patient visits if the patient is residing in a skilled nursing facility (“rehab”) and Medicare is paying for the rehab stay. They get a lower reimbursement called the “facility rate.” This can interfere with the patient's seeing their regular doctors and with continuity of care. In addition, doctors don't always really know where their patient is residing; and if they bill the regular amount, Medicare comes after them later and demands repayment, which causes them a lot of hassle and expense.
I became aware of this when a friend who learned her cancer biopsy was positive was not able to see an oncologist and learn the details of her condition, because she was in rehab. Her appointment was cancelled for this reason.
“Site-neutral” should apply to the patient as well as the doctor. If you let legislators know you want site-neutral payments and alignment of payments across settings, please also let them know that Medicare patients in rehab should be able to visit doctors the same as if they were residing at home.
Dr. Nancy Binford is right that higher payments to hospital-based practices than to community-based practices are a big problem. [“Opinion: Patients Shouldn't Be Charged More by Hospital-Owned Practices than Physician-Owned Practices,” Oct. 6] And, there's also another problem with differential payment based on location.
Physicians are not able to charge the same amount to Medicare for patient visits if the patient is residing in a skilled nursing facility (“rehab”) and Medicare is paying for the rehab stay. They get a lower reimbursement called the “facility rate.” This can interfere with the patient's seeing their regular doctors and with continuity of care. In addition, doctors don't always really know where their patient is residing; and if they bill the regular amount, Medicare comes after them later and demands repayment, which causes them a lot of hassle and expense.
I became aware of this when a friend who learned her cancer biopsy was positive was not able to see an oncologist and learn the details of her condition, because she was in rehab. Her appointment was cancelled for this reason.
“Site-neutral” should apply to the patient as well as the doctor. If you let legislators know you want site-neutral payments and alignment of payments across settings, please also let them know that Medicare patients in rehab should be able to visit doctors the same as if they were residing at home.
Regards, Anne Peticolas
