Foundation helps gain increase in phototherapy reimbursements for physicians
Goal is better access to effective treatments for patients
First posted Nov. 9, 2001
The situation was getting grim. Psoriasis day treatment centers were closing. More and more doctors in private practice were dropping phototherapy as a treatment option. Patients were losing access to ultraviolet light B (UVB), the Goeckerman regimen and PUVA -- three very effective treatments for psoriasis.
The problem? Doctors were being reimbursed by Medicare, the federal insurance program for the elderly and disabled, at such low rates for these treatments that doctors were actually losing money by offering the treatments to their patients. Regardless of how effective or how necessary phototherapy might be for patients, many doctors were no longer able to offer these money-losing treatments.
So, last year, the National Psoriasis Foundation and the American Academy of Dermatology (AAD) joined in an effort to bring about a solution: boost Medicare's reimbursement rates.
On Nov. 1, Medicare announced it would do exactly that -- more than double reimbursement rates for UVB and PUVA (the use of a light-sensitizing medication and UVA), and increase the reimbursement rate for the Goeckerman regimen by more than 50 percent. The change will not affect the co-payments Medicare patients pay out of their own pockets or through supplemental insurance. The new rates are effective Jan. 1, 2002.
The bottom line
According to surveys, doctors charge on average between $45 and $85 per visit for a UVB session.
For example, Dr. John Doe charges $65 for one UVB therapy session. Under Medicare policy, patient A is responsible for no more that 20 percent of the total charge, which in this case is $13. Patient A pays $13 out of his or her own pocket, or through supplemental insurance. That leaves $52. Under current reimbursement rates, Medicare is reimbursing doctors an average of $24, leaving the doctor to absorb $28 of the bill.
As of Jan. 1, 2001, patients are still responsible for 20 percent ($13), but Medicare will reimburse $50 for the UVB phototherapy session, leaving just $2 of the bill for the doctor to absorb.
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"An important part of the Foundation's mission is to be sure that people who have psoriasis and psoriatic arthritis have access to effective treatment," said Gail M. Zimmerman, National Psoriasis Foundation president and CEO. "Light therapy is one of the few basic therapies available for treating severe psoriasis. Its continued availability is vital. This increase in reimbursement will restore phototherapy as a therapeutic option for many more people."
With the help of a Washington, D.C., lobbying firm and significant assistance from the staff of the AAD, the National Psoriasis Foundation began working on getting Medicare to increase reimbursement rates in early 2000. The Foundation funded a preliminary survey on phototherapy use among dermatologists. Data collected from the survey confirmed the Foundation's fears: fewer and fewer physicians were offering phototherapy due to high costs and low reimbursements. Additional surveys revealed the fact that prices of phototherapy units and the salaries of staff to operate the units had been steadily increasing, but the rates doctors were being reimbursed for offering the treatments remained the same.
In January 2001, Mark Lebwohl, M.D., chair of the AAD's Psoriasis Task Force and a member of the National Psoriasis Foundation Medical Advisory Board, successfully presented the case to increase rates to a committee of the American Medical Association, which in turn recommended higher rates to the agency responsible for administering the Medicare program. Ms. Zimmerman represented the Foundation and people with psoriasis at that critical presentation.
"The big winners in this are the patients," said Dr. Lebwohl, professor and chairman of the Department of Dermatology at Mount Sinai School of Medicine of New York University.
According to the AAD, the average charge for a UVB session is between $45 and $85, depending on varying costs for equipment, malpractice insurance and phototherapists to conduct the treatments. Medicare now pays only approximately $25 of that fee. Moreover, many private insurance companies take their cue from Medicare and reimburse for phototherapy at similar low rates.
As a result, some treatment centers refuse to take Medicare patients at all, while others -- in Seattle, Southern California, Texas and Utah -- have closed entirely. Certain centers in New York do not accept any insurance payments; patients must pay the full cost of the treatment out of their own pockets to receive phototherapy.
As of Jan. 1, 2002, however, the National Psoriasis Foundation hopes this situation will change. The amount Medicare pays per patient for phototherapy will increase to about $50 for a UVB session. This may persuade more doctors to offer phototherapy to Medicare patients, and at the same time provide incentive for those that already offer phototherapy to continue.
Many private insurance companies follow the reimbursement rates set by Medicare. The Foundation can provide information and help in convincing your insurance company that phototherapy should be covered. For more information, call (800) 723-9166.
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