The Centers for Medicare & Medicaid Services (CMS) Physician Fee Schedule final rule for 2020 includes a big win for rheumatologists—a 15% increase in reimbursement for evaluation and management (E/M) services. This decision represents an historic hike in payment for these codes and resulted from 10 years of advocacy work by the ACR and other cognitive care specialists.
The change is set to take effect in January 2021 and is based on revised E/M code definitions developed by the American Medical Association (AMA) CPT Editorial Panel and RUC-recommended values for these services. It will replace the single payment rate policy for level 2–5 services that had previously been proposed by the CMS. The final Physician Fee Schedule also includes a new complexity code that can be added under certain conditions to reflect rheumatologists’ evaluations in cognitive care.
“We are thrilled that this final rule by CMS resulted in significant potential increases in reimbursement to rheumatology providers for their work,” notes Blair Solow, MD, chair of the ACR’s Government Affairs Committee (GAC). “This increase in reimbursement will enable us to recruit young residents into the field of pediatric and adult rheumatology, which in turn will lead to better access to rheumatology providers for patients.”
Reducing Administrative Burden
The immediate impact of this reimbursement increase on the practicing rheumatologist is to alleviate the pressure felt in caring for complex patients, according to Colin Edgerton, MD, FACP, RhMSUS, chair of the ACR’s Committee on Rheumatologic Care (CORC). “Proper valuation of E/M allows rheumatologists to spend the time needed with these patients, and to hire the professional staff needed to coordinate the complex needs these patients have. Similarly, the reduction in administrative burden through measures such as documentation simplification allows rheumatologists and rheumatology professionals to focus on patient care rather than on paperwork.”
Physicians are often required to spend significant time documenting in electronic medical records (EMRs)—often far longer than the face-to-face patient encounters, Dr. Edgerton adds, noting that “much of the documentation is clinically meaningless and is required only for coding and billing purposes—rheumatologists are eager to return documentation to a clinically meaningful exercise.”
Recognizing the Cognitive Specialties
The E/M reimbursement increase also sends an important message that cognitive specialties, such as rheumatology, are valued, which can make rheumatology practice more attractive to medical students and residents at a time when the field faces critical workforce shortages.
Timothy Laing, MD, the ACR’s liaison to the AMA’s RUC and CPT advisory committee, says this E/M increase is far and away the most significant he has seen during his many years of advocacy for payment reform. He notes that credit for this win is shared by many, including the GAC, CORC and ACR’s board of directors and executive committee members. He also points to the Cognitive Care Alliance as an important partner in lobbying and advocacy activities on this topic.
