Here is the AMA's View of
Co-Management
Proposed Resolution on Co-management
AMERICAN MEDICAL ASSOCIATION HOUSE OF DELEGATES
Resolution: 813(I-98)
Introduced by: American Academy of Ophthalmology
Subject:Limitations on the Use of Modifiers -54 and -55
Referred to: Reference Committee H (Richard Tompkins, MD, Chair)
Whereas, the Health Care Financing Administration (HCFA) established the -54/-55 modifiers to allow for reimbursement of services for "co-management" of a post-surgical patient by two physicians, and
Whereas, physicians and non-MD/DOs defined by HCFA as "physicians" have increasingly made use of these modifiers under circumstances that may not be consistent with their originally-anticipated purpose, and
Whereas, indiscriminate use of co-management, especially when the surgeon remains easily available, jeopardizes continuity of care by transferring significant post-surgical responsibilities to possibly less-qualified individuals, and raises ethical concerns about the appropriateness of such transfer, and
Whereas, in some circumstances, surgical referrals may actually have become dependent on willingness to participate in such arrangements, amounting to "legalized" fee-splitting, and
Whereas, HCFA has begun to recognize abuses occurring in this system, and appears to support explicit standards limiting unnecessary and inappropriate co-management, but also encourages that the issue be addressed at the local carrier level, therefore be it
RESOLVED, that the AMA support limitation on the use of -54/-55 modifiers (regarding surgical co-management) to circumstances that focus on the well-being of the patient and not the financial relationship between providers, and be it further
RESOLVED, that the AMA disseminate information about this proposed limitation on surgical co-management to HCFA, all local Medicare carriers, and major third-party payors, and strongly encourage incorporation of this principle in related policies.
Fiscal Note: No Significant Fiscal Impact
THIS RESOLUTION HAS SUPPORT!
In a recent survey of members by the American Society of Cataract and Refractive Surgery, member surgeons overwhelming supported the provisions of the AMA resolution.
AMA Reference Committee H Adopts the Resolution!
During the AMA's Interim Meeting (December 5-8, 1999), Reference Committee H adopted the resolution as proposed by the American Academy of Ophthalmology with the following ammendment:
RESOLVED, that the AMA support limitation on the use of surgical co-management to circumstances that focus on the well-being of the patient and not the financial relationship between providers, and be it further
RESOLVED, that the AMA disseminate information about this proposed limitation on surgical co-management to HCFA, all local Medicare carriers, and major third-party payors, and strongly encourage incorporation of this principle in related policies.
(Note: the reference to modifiers -54/-55 was removed from the resolution in order to include all surgical co-management, not just those billed with the modifiers.)
See Related Articles:
