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Electronic Letters to:
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eLetters: Electronic letters published:
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![[Read eLetter]](/icons/misc/sectionDOWN.gif)
Reimbursement differential between cognitive and procedural preventive medicine
- Christine A. Sinsky (30 June 2003)
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Christine A. Sinsky, Physician private group practice
Send letter to journal:
csinsky{at}mahealthcare.com Christine A. Sinsky
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Dr. Yarnall et al identify the time required to perform the preventive health care services recommended by the USPSTF. (1) Their data can be extended to illustrate the reimbursement differential between cognitive preventive services ($1.50/min) and procedural preventive care ($74/min). Review of the data in Table 2 results in a literature based estimate of 63.2 minutes of physician time per preventive medicine exam; time for completion of screening colonoscopy has been reported to be 8.11 minutes. (2) A large national insurer reimburses a preventive medicine exam at $95, and colonoscopy at $597, resulting in rates of $1.50/minute for preventive care, and $74/minute for procedural care. This disparity is even greater in the Medicare population. When a Medicare patient receives evaluation and management services for acute and/or chronic health care problems at the time of a preventive medicine exam, the costs of providing these services are subtracted from the costs of the preventive medicine exam, and thus the amount the physician is reimbursed for the preventive portion of the exam is further reduced. For example, a physician who provides a detailed E/M service and a preventive medicine service to a Medicare patient would be reimbursed only $64 for the preventive portion of the exam. ($137 for the preventive - 73 for the E/M service), resulting in a rate of $1.01 per minute of cognitive preventive services. Based on literature derived time estimates and representative reimbursement levels, primary care physicians are reimbursed at approximately 2% the rate of their proceduralist colleagues for preventive services. To the extent that reimbursement drives medical practice, this differential is concerning; to the extent that adequate reimbursement is necessary to support quality care, this differential is alarming; as an equitable distribution of health care resources, this differential is unsupportable. The differential between reimbursement for procedural and cognitive preventive services is cause for concern, and consideration of change. 1. Yarnall KS, et al. Primary Care: Is There Enough Time for Prevention?. Am J Public Health. 2003;93:635-641. 2. Garrett DW. Colonoscope Length and Procedure Efficiency. Am J Gastroenterol. 2002 Jan;97(1):6-8 |
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