Medicare Drops The Ax On Consultations For The Elderly Ill

I spent many years as a consultant hematologist practicing in the office and hospital, in addition to my role as an internist. Understanding both roles, I have difficulty with Medicare'[s recent pronouncement barring the use of  "consultation"  codes for billing and its requirement that consultant physicians bill the consultation as "new patient."  The function, intellectual requirements, educational requirements, costs of operation and stresses of a consultation practice are quite different from an internal medicine or primary medicine practice and it would be much easier to simply practice as a primary care physician on autopilot  than to have to, as a consultant, diagnose and treat very sick consultation patients with leukemia, lymphomas, fulminant blood disorders and bizarre rare conditions.  A new "internal medicine" patient could be seen in 20-30 minutes; a complex consultation patient would often take more than an hour for the first visit.

So I was not surprised when the Thursday afternoon physician lunch group, which is composed of physicians with consultative practices in different specialties, focused its attention on Medicare's billing decision and its financial and professional impact on the specialist consultants.  Some of these excellent physicians are already having financial problems operating their practices and are being forced to consider whether they should abandon taking care of really sick prople as consultants and take the less taxing and more financially rewarding path of practicing primary medicine. The inevitable consequence would be to reduce the ability of the elderly ill to obtain consultation from highly skilled experts.  Gosh - isn't that what the Medicare population is already worried about?