On July 12, the Centers for Medicare and Medicaid Services (CMS) issued its proposed plan for changes to the Medicare Physician Fee Schedule for 2019.1 Citing the need to reduce paperwork and improve patient care, the CMS detailed a number of changes to payments physicians receive from Medicare that could have a significant impact on rheumatologists.
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Among these proposals is a change that would collapse evaluation and management (E/M) coding levels into one level and impose an associated cut in reimbursement for E/M services.2 Under the proposed plan, physicians would receive a flat fee for reimbursement of E/M services regardless of the complexity of a patient’s condition. The goal, as stated by the CMS, is to reduce paperwork by eliminating the current payment schedule based on the complexity of the clinical visit (coded as visit level 2-5) and, thus, eliminate the need to audit against visit levels.
Where the ACR Stands
The ACR is deeply concerned about this proposed change and is taking a leading role among specialty organizations in urging the CMS not to move forward with the proposed cuts by emphasizing the need for appropriate reimbursement for complex critical care required for the practice of rheumatology and for the optimal care of patients. “The E/M services [provided] by rheumatologists are critical for effectively managing and reducing the long-term functional and economic costs of many debilitating diseases,” said ACR President David Daikh, MD, in a press release issued through the College.3 “These proposed cuts will have significant negative impacts on rheumatology practice.”
In prioritizing advocacy on this issue the ACR is building a broad coalition engaging with Capitol Hill and with CMS to stop this proposal from moving forward. The ACR is convening physician organizations and patient groups in coalition efforts to have members of Congress weigh in with CMS urging the agency to not move forward with the concepts as proposed, and instead work with stakeholders to identify other ways to decrease documentation burden that would not impair patient access to care.
Bad for Patients
In responding to the CMS proposals, the ACR emphasized the impact of reducing reimbursement for E/M services on the practice of rheumatology that would ultimately result in cutting off access to critical care for many rheumatology patients.
One primary way this could happen, says Angus Worthing, MD, the ACR’s Government Affairs Committee chair, is that rheumatologists may feel pressured to stop seeing Medicare patients because of insufficient reimbursement for E/M services.