This is why Republicans keep losing the healthcare argument. Shit takes from people who don’t understand the first thing about how healthcare is actually delivered. A patient walks into a physician’s office. The physician evaluates the problem. The physician determines a procedure is necessary. The physician can safely treat the patient right there, that day, in the lowest-cost setting. And Buzz Patterson calls that a “healthcare rip-off.” Seriously? What would Dr. Oz and Buzz the healthcare expert prefer? Yes, let's send Grandma home? Tell her to come back next week? Schedule another appointment? Another drive. Another train ride. Another copay. Another day off work for her daughter. Another opportunity for her condition to get worse. Solid strategy. Medicare already has longstanding multiple-procedure rules where, in certain surgical circumstances, the highest-valued procedure is paid at 100% and additional procedures are paid at reduced rates. That is not what we are talking about here. CMS is now proposing to apply that logic when a physician provides a separately identifiable E/M visit and a procedure on the same day. The most expensive service gets paid at 100%. The other gets cut to 50%. Centers for Medicare & Medicaid Services Think about what that means. The patient comes in with a problem. The physician evaluates her. Finds the problem. Can safely fix it immediately. And CMS says: great efficiency, we’ll pay you less. That is backwards. If the physician sends her home and brings her back later, we have preserved two separate encounters. If the physician solves the problem today, CMS says there is “overlap” and proposes reducing payment. And somehow The great wizard of Oz and his sidekick Buzz have turned that into physicians “double billing.” It isn’t double billing! These are separately identifiable services. CMS itself describes the policy as an attempt to account for what it believes are efficiencies and potentially duplicative resource valuation when an E/M and global procedure occur together. Fine. Debate the valuation. Stop pretending a physician evaluated a patient twice! And while we are suddenly so concerned about waste, perhaps Dr. Oz and Buzz could look at the gigantic payment distortion sitting directly in front of him: site of service. MedPAC has been documenting this for years. Its own 2024 example: Removal of skin lesions in a clinician office: $165 Same service category in a hospital outpatient department: $404 Same patient. Same basic service. Different sign on the building. $238 more. So let me understand the healthcare reform strategy: Physician evaluates you and treats you safely in the office on the same day: Cut one of the services 50%. Move care into a hospital outpatient department: Medicare may pay dramatically more. And these guys think they found the rip-off. Incredible. This is exactly how we create incentives for care to migrate into higher-cost settings. The independent physician who can diagnose and treat the patient in one visit gets squeezed. The hospital outpatient department carries a much richer payment structure. Then Washington wonders why independent practices disappear, insurance premiums rise, and everything ends up owned by a tax-payer subsidized hospital system. @DrOzCMS, this is the healthcare problem sitting directly in front of you. Fix site of service. Stop financially rewarding care simply because it happens inside an HOPD. Reward physicians who can safely diagnose and treat patients in their offices. Reward lower-acuity care. Reward efficiency. Reward the doctor who can fix the patient in one damn visit. Don’t punish it. FYI, if you'd have called 10 independent practices, they would have nicely told you this in 60 seconds. But you retards always think you know better. Stop harming patients!