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    ‘I can’t keep up’: Pay cuts, prior authorization take their toll

    State-level advocacy, effective communication crucial to addressing administrative burdens

    Ray Painter, MDRay Painter, MD Mark PainterMark Painter


    The Trump administration has promised to make sweeping changes to the U.S. health care system. At the time this article was written, we were still waiting to see what will replace the promised repeal of Obamacare and will address health care under President Trump as details become available.

    Also by the Painters - BCG instillation: Why you can’t get reimbursed for catheters

    Although changes in Medicare have not been mentioned, we are all hopeful that the new administration and in particular the recommended appointee for secretary of the Department of Health and Human Services (HHS), Tom Price, MD, will adopt a few new and more physician-friendly changes to the implementation of Medicare policies. As you may know, Dr. Price was a practicing orthopedic surgeon for 20 years before he being elected to Congress in 2004.

    Dr. Price has remained a delegate from Georgia to the American Medical Association. Dr. Painter has known him in that capacity for over 20 years, and has found him to be an individual who listens to his colleagues.  

    If change is in fact coming, it is imperative that physicians make their points heard. We are encouraging all to make their voices heard. Reach out to your congressmen at the state and local level or at least reach out to others that can take your issues to those who can make changes.

    Laws require interpretation

    With any law that is passed, three steps affect its impact on the practicing physician: the law itself, the regulations/rules that add the details required to implement the law, and the interpretation of the regulations.

    For example, the new Merit-Based Incentive Payment System (MIPS) was a part of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) to assist in justifying the repeal of sustainable growth rate, the flawed payment update formula. The 2,204-page final rule, which includes the regulations for MIPS, was published in the Federal Register on Oct. 20, 2016.

    Read - CMS data: Health care spending continues to rise

    “Interpretations” will continue to surface for years to come as the final rule is tested in the real world. The Centers for Medicare & Medicaid Services include in the final rule a few areas that are targeted for further development and implementation. HHS cannot change the law, but could change the regulations and the interpretations within the constraints of the law. The first year phase-in of the program is a good example of what CMS and HHS can do to remain compliant with the law while considering the impact to practicing physicians.

    Next: Administrative overload

    Ray Painter, MD
    Urologist Ray Painter, MD, is president of Physician Reimbursement Systems, Inc., in Denver, and is also publisher of Urology Coding and ...
    Mark Painter
    Mark Painter is CEO of PRS Urology SC in Denver.


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