The NC Medical Society is among nearly 130 physician organizations that sent a letter today to U.S. Representative Nancy Pelosi, Speaker of the House of Representatives. The letter urges the House to follow up on last week’s health system reform vote and pledges to work with the Speaker to achieve immediate passage of H.R. 3961, which includes a provision to repeal the sustainable growth rate (SGR) Medicare physician payment formula. Read the letter here.
at 9:09 am
We are happy to see we are all singing off the same page. One thing that needs to be included in any bill signed into law is the right of a medical practice to also be a medical BUSINESS. So may rules have been made by payers (government and private) that prevent a medical practice from being a successful business. The one that affects us the most as a solo primary care practice is the inability to bill for outside lab services performed by our office in the care of our patients. The small margin we make for these services allows us to cover overhead expenses such as the cost of medical assistants that do the phlebotomy and provide many other important services. Some payers say “pass through billing” for such services that you don’t do in the office is inappropriate. I would say that we do NOT make the bandages, make the diagnostic equipment, make the computers, create the medicines or any of the other things that comprise patient care but yet we still have to pay for these items from our income. I would also say that allowing large medical practices to bill for their labs due to affiliation with a hospital lab network puts the small medical practice at a competitive disadvantage. The medical business should be able to contract with other medical services to provide patient care within the pricing structure of the payers plan. Since many primary care practices are small, these non-payment policies threaten the medical home and availability of care.
Most private and current government payer programs expect all of the services to be covered by the below cost E&M payments. Medicare and Medicaid have eliminated any opportunity to cover the cost of care due to their rules to prevent reimbursement for ancillary services. For these reasons and the related below cost reimbursement, we no longer accept any government plans with the exception of Tricare. Tricare allows us to do “pass through billing” for labs. The small margin we make on those labs allows us to accept that government plan and still cover our costs. All government plans need to have the same payment rules for labs.
So in the end any new health care bill needs to recognize that the primary care physicians are businesses as well as medical practices. The bill needs to acknowledge the right of a medical practice to bill and profit from all of its services in order to stay viable. The issue of controlling costs by not paying for legitimate contracted lab services with the hopes of reducing utilization has gone too far.
Thanks to the Medical Society and AAFP for what you are doing. Please make sure we get this bill right. Please ensure you protect the majority of primary care medical practices by pushing to allow “pass thru billing” for labs we provide a patient in an office setting.
Sincerely,
Vince Winegardner
Family Healthcare of Lake Norman, PC