Loss of consult codes starting to take toll on urologists

According to a survey conducted by the American Medical Association and reported in American Medical News, a majority of specialists have seen their revenue decrease since the change, most by more than 5%. One in five doctors reported reducing the number of new Medicare patients, and 11% said they have reduced the time spent with Medicare patients. Other planned changes, according to the survey, include postponing the purchase of equipment (39%), cutting staff (34%), avoiding patients with complex conditions (22%), or not providing consultation patient reports (19%).

Urology Times wanted to know what impact the loss of consultation codes has had on practicing urologists. Has it impacted you financially? While some urologists say the effect has been minimal thus far, others report income losses of up to 20%, cuts in staff, and delays in purchasing new equipment.

"It really hasn't affected us at all, because we've picked up our volume and have been able to offset the lost income from consultation codes," Dr. Diaz said. "We've probably increased our workload by 10% to 15%, but it hasn't really taken a conscious effort. It wasn't that we made a decision to do that."

Dr. Diaz, in practice for 8 years and a member of a 16-physician group, has continued handling consultations in the same way he always has. Although not pleased, he can understand the rationale behind the elimination of the codes.

"I know some people have stopped sending consult letters out, but I still do them. Nothing for me has changed," he said.

"Obviously there are reasons they had consult codes. They're asking for an expert's opinion and we have to review more records and generate a report. It all takes time.

"From a consult's perspective, it would seem that you should get paid more, but from a health policy and economic viewpoint, I can understand the elimination of the codes."

Income drops 15% to 20%

In Sunnyvale, TX, Nabeel Syed, MD, is part of 400-physician multispecialty group outside of Dallas. He says his group has definitely felt the impact from the loss of the codes.

"We've lost 15% to 20% of the income we were making before," Dr. Syed said. "We're working harder and not getting the reimbursement we were before. We haven't cut staff; we're just eating the cost."

Dr. Syed feels a responsibility to continue doing consults the way he's always done them, but he isn't necessarily doing as many.

"I still write the letter, just because I feel obligated to the doctor who referred the patient to me. I haven't changed that.

"It is confusing in the hospital, however, because it's still not clear how to code a hospital visit. It's always a consult in the hospital and usually an emergency situation.

"I've started dragging my feet on hospital visits because we don't get reimbursed any more. It takes time to rush to the hospital to see one patient when you've got 10 people sitting in your office," he said.