The Centers for Medicare & Medicaid Services (CMS) has proposed revising reimbursements for physicians who treat Medicare patients. It would be a flat fee reimbursement for all 10-15 minute medical visits- the same amount of money for a cold, metastatic breast cancer or Parkinson’s disease. At first glance it may seem like a great idea to remove the many levels of payment and reduce paperwork. However, a mere scratch on the surface of this logic finds many unintended, catastrophic consequences at play.

Older adults, on average, have at least three serious health conditions. The proposed reimbursement revision would reduce the amount of time a specialty physician could spend with people who have diseases that are difficult to manage. An estimated 42 million people experience a movement disorder in the US – nearly 14% of the population. In Arizona, for example, more than 30,000 people are impacted by Parkinson’s Disease (PD) alone. This chronic, degenerative neurological disease requires the care of a specialist. People with PD need to discuss changes in cognition, sleep disturbance, anxiety, depression, hallucinations, severe constipation, and other symptoms with their physicians.

In our extensive work as a non-profit serving people with PD, Parkinson & Movement Disorder Alliance (PMDAlliance) has heard countless examples of the necessity of comprehensive specialist exams. Susanne, a person with Parkinson’s disease, described a recent visit to the ER due to frequent falls caused by sudden drops in blood pressure. She was referred to her PCP who referred her to a cardiologist. After learning she had no heart issues, she was sent home. She fell again. After an exam with her movement disorder specialist (a neurologist with advanced training in Parkinson’s and movement disorders) she was diagnosed of with neurogenic orthostatic hypotension (nOH), a form of hypotension caused by Parkinson’s, not heart disease. The intensive exam and discussion likely saved Susanne from additional falls and emergency room visits.

Another example is Thomas who has been acting out his dreams for the last several years due to REM Behavior Sleep Disorder, a common condition for people with PD. Thomas was unaware of how much more aggressive he had become at night and it became a safety issue for his wife Barb. With his specialty movement disorder neurologist, the couple was able to have a lengthy discussion of his symptoms and other contributing factors in order to address the situation thoroughly.

Specialty physicians need the time and the rightful reimbursement in order to treat patients correctly! In just the first six months of this year, PMDAlliance has worked with over 17,000 people with PD and this extensive experience makes clear the need for quality health care and adequate time for people to discuss this complex disease with their physicians. In the long run this will equate to a tremendous cost savings for an already stretched healthcare system. Creating a flat rate for physician appointments might be sufficient for primary care but it is dangerous and will likely result in poorer health care for the aging population.

CMS is taking public comment about this dangerous proposed change, CMS-1693-p, until September 10, 2018. Visit the CMS site at to make an electronic comment and follow the “Submit a comment” instructions. You can also comment by regular mail to the following address: Centers for Medicare & Medicaid Services, Department of Health and Human Services, Attention: CMS-1693-P, P.O. Box 8016, Baltimore, MD 21244-8016. Allow sufficient time for mailed comments to be received before the close of the comment period.

PMDAlliance is a nonprofit organization providing educational conferences, training for support group leaders, care partner retreats, online education, socialization and exercise, and more for people impacted by Parkinson disease and other movement disorders. PMDAlliance serves people across the United States and is not affiliated with any medical practice or institution. As an independent organization, our primary role is to build capacity for people impacted by movement disorders to live life more fully.

Contact: Sarah Jones, PMDAlliance CEO, 800.256.0966, or sarah(at)pmdalliance(dot)org

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