By George Capsis
I have macular degeneration in my right eye and became aware that my eyesight was getting worse. I started to condition myself to accept it as one of the penalties of old age but my eye doctor said, “No, you have a bit of debris from the insertion of an artificial lens and you need to go to the laser doctor who put it in and get it removed.”
Oh wow! The appointment was about six weeks away and the eyesight got worse; I tried covering up the left eye to confirm if I could see better with only the right one. I finally cabbed up to 40th Street and waited 30 minutes in an ice-box cold waiting room while I watched on a screen the very operation I had—the slicing open of the eye to remove the defective lens and the insertion of the new one—ugh.
At last, they escorted me into the chair. I then waited and waited. “Did the doc go to lunch?” I asked an assistant. “No, he is with another patient.” But, what the hell, I was in his office, in THE chair, and my vision would be corrected in minutes.
“Let’s take a look,” the doctor finally offered and swung his examination apparatus in place. “Yes, I see it. I will set up a meeting for you to remove it.”
I found myself blurting out, “Another meeting? No, I want you to take it out now!” and viewed a startled doctor with a look of surprise and guilt as he said, “But I wont get paid.”
I did not know what he was referring to but found myself saying, “I don’t care, I’ll pay—let’s do it.” Shamefaced, he demurred, “No, no, I’ll do it.” The laser machine went blat blat blat and, in 10 seconds, the debris was gone.
“What is this all about?” I asked WestView contributor Dr. Alec Pruchnicki and he explained: If in a single visit a doctor completes two procedures, he gets paid 50% per procedure. If he does three, he gets 25%.
I asked our brilliant Stanford intern, Nan Victoria Munger, to do some research on the topic. Although it gets a little technical, the bottom line is that a Medicare ruling very stupidly allows the doctor to get paid less if he does multiple procedures. So, some doctors space out procedures in order to obtain the full fees. For me, that would have meant living a few more weeks with a very bad eye and taking three hours to cab up again for 10 seconds in the chair. Now you KNOW this has to be wrong.
This is what Nan discovered:
In the 1980s, a Harvard study found that having multiple procedures performed in the same visit reduced physician work by roughly 50%. Probably as a result of this study, in 1992, Medicare introduced the Medicare Physician Fee Schedule (MPFS) and the Multiple Procedure Payment Reduction (MPPR) “with the rationale that there are savings associated with multiple procedures performed during a single encounter.”
MPPR means that Medicare pays less for the second, third, etc. procedures done in the same visit (except endoscopies). The rationale is primarily this: Every procedure includes pre-procedure and post-procedure work. When multiple procedures are done on the same day, Medicare says that the pre-procedure and post-procedure work often overlap between the two procedures. They feel that they would be overpaying if they paid the full cost of both procedures.