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CMS Billing Rules Subjugate Family Medicine – Incentives to Over-Test

July 14, 2014

I’m continuing my series on the reasons there are so few family physicians in the U.S. and why the Center for Medicare and Medicaid Services (CMS) is a root cause of this deficit. My conclusions are based on recent research on the topic.

This specific issue is a detail that actually wasn’t mentioned often in our study interviews. This is a reality that most family physicians are not very aware of, because the rules are so ridiculously complex.

The problem about testing is that there is an incentive for physicians to order more tests. More tests justify higher allowable physician fees. This means there is a disincentive built into the system for family physicians to behave like family physicians.

For example, if a doctor sees a patient with chest pain and orders lots of tests, he can potentially charge the highest fee. If the doc merely reassures the patient and orders no tests, the most Medicare will pay for that visit is about $40.

This situation is clearly wrong and is one more reason a solution for our healthcare system to promote primary care is to dump the CMS billing rules.


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