Independent physicians will face a moral calculation with every Medicare patient ……………………….
By Sally Primus – Physician, Practice Owner, and Healthcare Systems Speaker
THE QUIET MORAL CALCULATION BEHIND EVERY SAME DAY PROCEDURE I DO
Medicare has proposed a change that would cut reimbursement by 50% on one of two services billed the same day, the office visit or the procedure, whichever is priced lower. In most of ophthalmology, that means the visit itself.
The calculation this creates a dilemma, because I think most patients have no idea it’s happening in the background of their care.
Ethically, my answer is simple. If a patient needs a procedure, I want to do it. Full stop. Financially, it’s not that simple anymore. My practice already runs on thin margins. I make less than I would as an employed physician at a large health system, by choice, because I value the autonomy of running my own practice.
This proposed cut takes a real bite out of practice revenue every time I combine a visit and a procedure into one appointment. I have no doubt how larger hospital systems and private equity backed practices will respond. They will require patients to schedule the visit and the procedure on separate days, protecting their revenue on both. That is not a guess, it is simply the rational response to this incentive structure, and it is already the direction I expect the industry to move.
Here is where I hope I am different, at least for now. Being independent means I still get to make that call myself, case by case, instead of a corporate policy making it for me.
Did you drive an hour to get here? Are you elderly, or dealing with limited mobility that makes a second trip genuinely difficult? There is a real chance I will still do both in one visit, and simply absorb the loss on that day, because it is the right thing to do for that specific patient in front of me.
But I want to be clear about the cost of that choice, and who ultimately pays for it if this proposal moves forward as written. For patients on Medicare Advantage plans specifically, splitting a visit into two separate days does not just create inconvenience, it can mean a second copay out of their own pocket, for care that used to be delivered in a single trip.
So we would be looking at a policy that pressures practices to fragment care, adds a second bill to some of the patients who can least afford it, and quietly pushes more independent physicians toward employment models where that kind of individual judgment call simply is not part of the job anymore.
I think more of us in medicine need to be speaking up about this now, while it is still a proposal and not yet a rule.