Last week, CMS released their proposed fee schedule for 2019. Usually, this is a non-event, but not this year. This year, in addition to releasing the proposed fee schedule, they also released a number of changes to how CMS is going to pay doctors, as well as a number of other things. The biggest change is a proposed change in the way office visits are reimbursed. CMS is proposing to go from five levels to two in the new proposed fee schedule. There will be a payment for a level one code, and then the same payment for levels two through five. Let's take a closer look at the numbers. CMS is proposing that a level two visit will go from $45 to about $92. On the other hand, a level five visit will go from about $150 today to $92. One is receiving a huge increase, while the other is receiving a huge cut. Now, it's important to note that CMS is not proposing to spend any additional money. Their expenditures would be roughly equal under either program. What they are doing is essentially redistributing that money or redistributing income. Let's analyze the winners and losers under this proposal. First of all, primary care specialties like internal medicine and family practice are expected to be net neutral. Both specialties would receive roughly the same amount of money in 2019 as in 2018. However, specialists are impacted the most. The proposal takes money from those specialists that tend to have shorter visits, such as many surgical specialties and lower complexity non-surgical specialties, and gives them more money. On the other hand, it takes money away from specialties that have longer or more complex visits. Now, let's put this into perspective. Under this proposal, dermatologists would receive about a 25% increase...
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