RFK Jr. to Change Medicare Payments Forever

The Shifting Dynamics in Washington DC

President-elect Donald Trump has appointed Robert F. Kennedy Jr. to head the Department of Health and Human Services.

Kennedy has since been drafting plans to implement Trump’s “Make America Healthy Again” agenda, which focuses on addressing the root causes of chronic diseases and childhood illnesses.

His appointment is subject to Senate confirmation.

Robert F. Kennedy Jr. and his team are exploring a potential overhaul of Medicare’s long-standing payment structure.

The Problems with the Current System

The goal is to realign the health system’s focus on primary care and preventive services. The plan is to evaluate thousands of CPT codes that dictate how much physicians are compensated for various procedures and services, and this could impact other professions as well.

The current coding system has long been criticized for

• favoring expensive surgeries and procedures
• encouraging physicians to specialize rather than pursue primary care
• treating chronic problems instead of preventing them

Policymakers have long cautioned about the flaws in Medicare’s billing codes and their misaligned incentives, but the issue has struggled to gain national traction.

This is a challenging subject to explain to the public since there are many technical details surrounding billing codes. Also, there are entrenched financial interests with industry groups relying on the current payment structure to maximize their revenue.

How AMA Decides Revenue for Physicians

Medicare’s billing codes are largely shaped by the American Medical Association (AMA), which represents over 250,000 physicians across the country. The AMA has a panel which adopts certain CPT codes and makes recommendations about which codes (and amounts) should be paid. Most of these 'suggestions' are accepted by the federal government.

The AMA also generates millions of dollars annually from its involvement in creating and recommending billing codes. This revenue comes from conducting training sessions, selling reference books, and charging royalties.

For decades, lawmakers have questioned why physicians have a hand in determining their own federal payment rates.

The Tide is Shifting for the AMA

Kennedy and his team are reportedly seeking to collaborate with the AMA to revise the billing codes, according to a source familiar with the discussions.

The AMA has defended its process, arguing that some critiques are outdated.

It also emphasized that hospitals, health insurers, and other industry stakeholders contribute input to Medicare, influencing payment rates for their respective sectors.

Any federal effort to reform the allocation of billions of dollars in annual payments to healthcare providers is likely to trigger fierce lobbying aimed at blocking the changes or redirecting them to favor specific procedures.

CMS Under Fire by Incoming Administration

The Centers for Medicare and Medicaid Services (CMS) oversees the implementation of billing codes. On Tuesday, President-elect Trump named Mehmet Oz, a cardiothoracic surgeon and well-known TV personality, to head CMS.

“The current CMS codes uphold a system that profits from Americans getting sick,” Kennedy adviser Calley Means wrote on X, commenting on Oz’s appointment.

If confirmed, Kennedy and Oz could overhaul the Medicare coding structure.

Calley Means, NYTimes Best-Selling Author of "Good Energy: Transform Your Life Through Positive Vibes" had this to say:

What You Should Do Next

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Schedule a call with us to learn more. No contracts, no setup fees, no cancellation fees. Pay as you go and make us an extension of your clinic.