We are doctors who have grave concerns about an upcoming, dysfunctional change to Medicare. On January 1, 2010, Medicare will abolish consultation codes. When a specialist is asked for his/her expert opinion on how to care for a patient, the visit is coded as a consultation; these codes appropriately carry higher reimbursement rates than standard office visits. Traditionally, the specialist then returns the patient to the primary care physician or, if necessary, sees the patient through the clinical problem until resolution.

As specialists in neurology and ophthalmology, we can tell you that, without question, this change represents a tremendous undermining of quality medical care. Essentially, the value of a specialist is no longer recognized. While the politicians can make headlines and boast about their cost-cutting prowess, in the fine print, it is ordinary patients and their physicians who suffer the most. Unfortunately, our government is sending a message loud and clear that specialty care is not valuable in the United States.

Equally worrisome is the fact that when these changes take effect, many specialists may elect to “opt out” of caring for Medicare patients. This will leave patients struggling to find a doctor or having to pay out of pocket for specialty care. It is ironic that we may soon have universal health care, yet physicians will be so devalued that all the newly insured will be unable to find a doctor. If you or a loved one has received quality care from a specialist, please consider this legislation as a “shot across the bow.” We urge you to contact your elected representatives and ask them to support the Specter (D-PA) amendment to The Patient Protection and Affordable Care Act (HR 3590). This will enable specialists to continue their work caring for you. -Philip R. Delio and Mark Silverberg


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