Physian's Changing Attitudes

Doctors have always encountered the problem of how to best tell their patient of a terminal sentence. Recently, medical professions have been more upfront about tragic news such as this. Physicians used to think that by not telling a person they were dying, it would boost their moral and increase their hope.

During 1961 only 10% believed it was correct to tell a patient of a fatal diagnosis. This changed after studies were done that revealed nearly 90% of patients said they would like to know the truth of their prognosis.

By 1979, physicians had completely reversed their beliefs and a survey revealed that 97% felt full disclosure was the correct course to take.

Physician Pay Cuts

This is one more example of the type of change that has been happening for the past few months, and virtually hidden by the healthcare bill debate. As part of the healthcare bill in the Senate now, Medicare would give 10% bonus payments to primary care and family physicians as a workforce incentive, but half of that bonus would be financed by cuts in surgeons' pay. This would have an especially discouraging impact on the workforce of surgeons in underserved and rural areas.

Regardless of whether the bill passes, as of Jan. 1, the Centers for Medicare and Medicaid Services plans to eliminate a series of five-digit CPT codes that specialist physicians, such as cardiologists, oncologists, and surgeons, use to bill for medical or surgical consults. These consults occur at the request of a practitioner who wants a specialist's opinion regarding his or her patient. For example, an internist may want his patient seen by a vascular surgeon, or a family practitioner may want her patient seen by an endocrinologist or pulmonologist.

Under current rules, the CPT code for consultation calls for reimbursement that is between $20 and $50 higher than for a comparable office visit. But by eliminating the CPT codes, those specialists will be forced to bill under a different payment code bracket, which covers for a simple office visit.

First, the patient's condition must have added complexity or it wouldn't have needed referral. Second, the specialist performs an independent physical and often gets a separate history of the patient, spending as much as an hour to set a correct diagnosis and course of care. And third, reimbursement policy requires the specialist physician to return to the referring physician a written report of the findings and course of care. It shows that we do not need a new bill to control healthcare. Some are so set to change the world, that they cannot wait.