FORT WORTH (CBSDFW.COM) – When Dr. Mary Quiceno of Fort Worth first heard about Medicare’s proposed changes to how it pays doctors, she worried about her practice.

That’s because while Medicare will increase reimbursement for some doctors visits, it will reduce what it pays for the highest levels of care that Quiceno’s practice provides.

Most of the patients at the UNT Health Science Center’s Center for Geriatrics are on Medicare, and she is a neurologist who specializes in dementia.

Dementia is not a single disease in itself, but a general term to describe symptoms of impairment in memory, communication, and thinking.

“We’re mostly billing for the complex medical decisions that we’re making and the complex treatments that we’re giving our patients,” explained Dr. Quiceno. “So we’re billing at higher levels of complexity and timecodes. We’re spending at least half an hour with a patient and we’re prescribing medications that are very serious and need a lot of monitoring.”

Under Medicare’s proposal, doctors who see new patients would see their rates for level one, the most basic care cut from $45 to $43.

Levels two through five now have reimbursement rates between $76-$211, but under the proposal, those levels of care would all be reimbursed at the same rate for new patients: $134.

It’s a similar story for existing patients.

For level one care, doctors reimbursement rates would increase from $22 now to $24.

Levels two through five, which now average between $45-$148, would all be reimbursed at the same rate for existing patients: $92.

“We’re going to see depending on your billing there a 10% to 40% cut in reimbursement, so it’s quite a bit,” said Quiceno.

The Centers for Medicare & Medicaid Services though says its proposal will slash paperwork doctors will have to provide medicare, so they can spend more time with their patients.

But the government calls its proposal, “Patients over paperwork.”

On its website, Administrator Seema Verma said, “This proposal alone is one of the most significant reductions in provider burden ever taken by any administration, and the overall impact is significant.”

Dr. John Carlo’s practice in Dallas has a small percentage of Medicare patients, but says the paperwork is still a big headache.

“For every hour spent on direct patient care, doctors face another two hours of administrative work around using their electric health record, following up on all the billing and administrative paperwork. We are tired. Physicians are tired of all the paperwork. We want to see patients, we don’t want to be involved sitting behind a computer filling out paperwork late into the night.”

He’s a member of the Dallas County Medical Society, which is now reviewing the plan and hasn’t taken an official position on it.
Carlo said he still doesn’t know enough to give it a thumbs up or thumbs down. “Sounds like a great idea, but I really think it’s the details that are going to be important.”

Quiceno said many doctors won’t treat Medicare patients as it is already, and worries what will happen next. “I think for a lot of physicians, this may be the turning point, where they don’t accept medicare patients any longer.”

Congressman Michael Burgess, R-Lewisville, who’s also a doctor, chairs the Subcommittee on Health, the subcommittee that oversees Medicare, and he welcomed the proposal. “This proposed rule is far-reaching in its efforts to reduce burden and will help encourage the transition to value and modernize that the Medicare program by adapting to new technology. I am encouraged by the Trump Administration’s continued action striving to put patients first, and look forward to working with CMS Administrator Verma as these proposed changes come to fruition.”

The public has until September 10 to give input to the federal government about the proposed Medicare changes.

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