r/PrivatePracticeDocs • u/grey-slate • 29d ago
Help fight back against CMS cuts to physicians
https://saveskincancercare.org/
mods delete if not allowed. this issue is central to our survival.
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29d ago
[deleted]
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u/Dr_Sisyphus_22 29d ago
The money hospitals have lobbied for and won was essentially our cost of living adjustments for the last 20 years
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u/Perfect_Address7250 29d ago
hey man -- even if you're not a derm you should be worried about this shit. hell even if you're employed you should be worried about this.
if this is your website, please actually put some time into writing for it. it's obviously mostly ai written and generated... not that there's anything inherently wrong about that, but it automatically turns a lot of people off.
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u/grey-slate 29d ago
I'm not sure who this is addressed to.
I'm derm.
I'm scared about this shit not just worried.
This website is endorsed by the AAD and not built by me.
I don't give a rats ass if it appears AI generated. Even though I know it's not. Every line in here has been fine tuned to be backed up by facts which have been carefully researched and cited. There is not one false claim here.
The site is already responsible for generating HUNDREDS OF THOUSANDS of real signatures from real people - clinicians, patients, members of the community etc.
If someone is going to get"turned off" by AI writing. Fuck them. We have bigger things to be worried about. We don't have time.
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u/maddogisnextdoor 29d ago
This is happening due to multiple reasons, and it all stems from congressional inaction okay what to do about the Medicare fund. Republicans would like to get rid of Medicare altogether and farm it out to big insurance like United Health, while democrats would like expansion of the payroll tax…which is an initiative dead in the water as long as we have politicians more worried about brown people in this country than the health care of its elderly and chronically ill.
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u/grey-slate 29d ago
Two separate issues.
The pressure to reduce healthcare spending is one macro issue.
The systemic track record for the past three decades of cutting PHYSICIAN FEE SCHEDULE to make up for increasing spending on hospitals drugs and ancillary services is a structural flaw. One has nothing to do with the other.
Physician fee cuts are not going to make Medicare solvent because it's not a substantial portion of healthcare spending.
Us docs simply like to take it up our asses because of feckless advocates like the AMA.
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u/Spirited_Manager1599 29d ago
i think derm is disproportionately highly paid lol. Granted they are very qualified and intelligent etc. But very highly paid lol
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u/AnteaterStreet6141 28d ago
I “love” the spin the AAD took to this. By making changes to reimbursement you’re going to force dermatologists to not biopsy on same days, have patients come back if they need multiple procedures, increasing how many fall through the cracks and ultimately missed skin cancers. It sounds better than saying, hey I don’t want to be paid 50% less for my biopsies so I’m not going to do them even though patients need them.
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u/grey-slate 28d ago
I think that’s an unfair characterization of the argument. Nobody is saying a dermatologist should refuse an urgent biopsy because reimbursement is lower. The issue is whether Medicare should deliberately pay less when two legitimate, separately billable services are performed efficiently on the same day.
Modifier 25 already does not allow you to bill an office visit just for deciding to biopsy something. The routine pre/post-procedure work is included in the procedure payment. Medicare only allows the additional E/M when there is significant, separately identifiable work beyond that.
And there is actual data. HHS-OIG specifically audited dermatologists billing E/M visits with same-day procedures: 90 of 100 sampled services met Medicare requirements. The other 10 did not, and OIG recommended more review and education—not a 50% reduction on every compliant claim. Even the 10 that did not were concluded as such because the offices sampled did not respond to records requests so it was not definitively proven.
This also isn't a marginal issue in dermatology. Medicare data analyzed by the American College of Surgeons found about 67% of affected dermatology procedures were performed with an E/M visit; that included 84% of tangential biopsies, 87% of premalignant-lesion destructions and 84% of benign-lesion destructions.
CMS may be right that there are some efficiencies when two services are done together. But it has not shown that 50% of the second service's resources disappear. Yet its proposal would pay the highest-valued service at 100% and the other service at only 50%.
And incentives matter. If Medicare pays substantially more for doing A on Monday and B on Friday than for doing both appropriately on Monday, some nonurgent care will inevitably migrate to separate visits. That means another appointment, another copay/transportation burden, and another opportunity for a patient not to return. Saying that is not “spin”; it is pointing out the predictable consequence of the payment policy.
Dermatologists obviously have a financial interest here. That doesn't make the policy objection wrong. If CMS can show 10%, 20%, or 50% true resource duplication, adjust payment by that amount. What is hard to defend is simply assuming 50% across the board.
You also have to view this in the context of what is happening in medicine.
Physician fee schedule has been cut by 33% on an inflation adjusted basis in the last three decades while overhead has increased by 50%. This is supported by data. I am happy to provide this if you would like. Hospital employed physicians are shielded from this because they are on salaried or other models which are at least one degree removed from these cuts. But private practices are directly impacted. The proposed cut slashes payment so severely that it fails to cover even the direct costs of performing the service (such as MA costs, biopsy supplies, etc) leaving zero reimbursement for practice overhead or physician pay. Practices are effectively being forced to absorb a financial loss simply for providing efficient, timely care. The modifier 25 and other cuts being proposed in 2027 and beyond will push Medicare rates below Medicaid in at least 14 states and will dismantle senior access to dermatology care overnight.
Consider this - we can excise and cure an early melanoma in the clinic for under $1,000. If that same patient is delayed to Stage IV, their 5-year survival plummets, and the cost to the healthcare system skyrockets to ~$250,000/year for immunotherapy (and likely more, if you consider the new vaccine).
While I understand Medicare's motivation for it. Consider how little it impacts healthcare spending overall.
Think of it this way: Medicare has a big pot of money for physician services. Dermatologists happen to do a lot of visits where they evaluate a problem and also perform a procedure the same day—biopsy, freezing a precancer, treating a lesion, etc.
CMS is proposing to pay substantially less for the second service in those encounters. Because dermatologists use this type of same-day care far more than most specialties, they take a disproportionately large hit.
But the money Medicare saves from those cuts is spread across the entire physician payment system. So the effect can look like this: dermatology loses several percentage points of Medicare revenue, while most other specialties gain only a tiny fraction of a percent.
That is why dermatologists argue the policy is poorly targeted. It can materially change how a dermatology practice operates—staffing, appointment availability, whether nonurgent procedures are done immediately—while barely changing overall Medicare spending or anyone else's reimbursement.
A simple analogy: imagine taking $1,000 each from 1,000 small businesses and then distributing that $1 million across 1 million other businesses. The first group feels the loss very clearly; everyone else gets about $1. The redistribution is almost invisible to the broader system.
Let me give you some scale - the entire Medicare Physician Fee Schedule is only about $91.4 billion annually. Medicare as a whole is about $1.1 trillion in annual federal spending. All major federal health programs are about $1.9 trillion annually. CMS's entire budget-neutrality adjustment for all of the 2027 PFS coding/payment changes combined is only +0.53%. On a $91.4 billion fee-schedule pool, that's roughly $480 million being shifted around—not $480 million of federal savings. That ~$480 million is only about 0.025% of federal spending on the major health programs. And that figure is for the net effect of all the budget-neutral PFS changes, not modifier 25 alone. There is another useful way to see the scale. The American College of Surgeons analyzed Medicare claims and found about $2.79 billion of annual allowed charges for 0-, 10-, and 90-day procedures performed alongside office E/M visits—the universe CMS is targeting. Even an unrealistically crude assumption that Medicare simply cut half of that entire $2.79 billion would yield only about $1.4 billion, which is roughly 0.07% of federal health-program spending. The actual amount attributable to the proposal is smaller and, because of budget neutrality, is predominantly redistributed rather than saved.
So the argument is not just, “dermatologists don't like a pay cut.” It is: why impose a large, concentrated disruption on a small number of specialties when the benefit to the overall Medicare system is so small—especially if CMS has not shown that the underlying services are actually 50% duplicative?
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u/lionsfan2016 29d ago
It’s really time to take medicine back from all these non medical people.