Part B Insider (Multispecialty) Coding Alert

As the nation's over-65 population doubles between 2000 and 2030, patients will be demanding more physician services from Medicare, according to Ed Salsburg, associate vice president of the American Association of Medical Colleges. In particular, oncologists will be in short supply, Salsburg told the Medicare Payments Advisory Commission-s April meeting.

The real problem isn't a shortage of doctors, but a shortage of primary care doctors, argued Kevin Grumbach, chair of the UCSF Center for California Health Workforce Studies. Medicare still pays more for a doctor's time if he or she is doing a procedure (like a colonoscopy) than if he or she is just talking to the patient, Grumbach pointed out. So Medicare may be encouraging more doctors to become specialists and creating a shortage of primary care doctors.

Grumbach suggested dividing Medicare's physician payment update formula into two systems: one for evaluation & management visits, and one for procedures. Because the increase in costs all comes from surgical procedures, Medicare could target that spending growth without hurting primary care doctors.

Another possibility: Medicare could do more with nurse practitioners and other physician extenders, which would put doctors in more of a supervisory role, panelists said.