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Idea for doctor visits


I do not know if you can help with this.  I am a family doctor in Amarillo Texas and I have sent a longer copy of this idea to our congresspeople.  I had an idea to help with costs (particularly for Medicare).  It was a simple addition to the CPT (the codes used in offices and hospitals for visits, procedures, etc).  My idea was to add 5 visit codes, to be used by primary care doctors, for following up on patients who had been hospitalized for a "serious medical condition".  The condition could be any one of the top 20-25 codes that Medicare sees; I am confident they could generate such a list in a second or less. Pediatric patients could have their own list.  If a patient had been hospitalized with one of these conditions, and perhaps one other condition or any sort, and the patient had been home for less than 1 week, then the first of the 5 codes would be used.  Medicare could even require that the patient be seen within a week of discharge.  The "level 1 code" would pay (be reimbursed by Medicare) at around the same as an office visit. If the patient were then seen within a month post-hospital discharge, then the 2nd code would be used. This would pay more than the first code.  At 3 months, the 3rd code would be used, which would pay more, and the 4th code would be used at 6 months, and the 5th code would be used after a year.  The 5th code would pay 2-3 times as much as the first code.  This would provide an incentive for doctors to take good care of their patients, who could always go to the hospital if they got sick.  The codes could not be used by specialists, as they are typically only worried about their little piece of the patient.  Take heart failure as an example.  I could see the patient every other week (26 visits over a year) and not come close to the costs of hospitalizing the patient for 3 days in the ICU.  As I told our congressman, this would have two drawbacks: (1) it encourages creativity, which is generally shunned by Medicare and the government; and (2) it is simple and elegant, again not generally a plus when dealing with Medicare.  Hospital care is the most expensive care there is (the most expensive hotel room in town resides in the ICU), and providing an incentive to keep patients out of the hospital would save a great deal of money. I am not a shill for insurance companies or (gasp!) Medicare.  I am just trying to encourage greater efficiency in the system by rewarding care that results in less hospitalizations.  I wanted to know if you knew how to get ideas, like this, in front of the people who could make it happen.    Thanks for any feedback.  Randy Hines, MD.