Medicare pays on a geographically differentiated basis, even though service costs may not vary. Medicare carrier policies often require physicians to reduce the number of tests or confine tests ordered to specific diagnoses, whether or not it makes sense in individual cases. The policies also add to the documentation requirements of physicians and discourage testing that may be medically appropriate. Fischer used far fewer words. Now, you've got to support all diagnoses, and everyone is changing the rules under which diagnoses can be supported.
Nobody really knows what kinds of rules they're working with.
The Academy statement said a better payment methodology would meet guidelines spelled out in AAFP's policy on physician reimbursement. One option would be paying for clinical lab services under the resource-based relative value scale that Medicare uses for other physician services. But it also noted that POLs and large reference labs could not bid on equal terms. AAFP's statement also addressed the direction POLs might take given the constant introduction of new lab technology. Fischer suggested national guidelines for reimbursement and a better range of common tests in evaluation and management coding as possible solutions.