NEW YORK (Reuters Health)—The proposed collapsing of payment amounts for levels 2 to 5 evaluation and management (E/M) services by the U.S. Centers for Medicare and Medicaid Services (CMS) would have different financial impacts on different specialties, researchers report.
“Specialists that tend to have more complicated and/or longer visits would lose money, and specialists that have less complicated and/or shorter visits would make more money,” Dr. Brian C. Callaghan of the University of Michigan Health System, in Ann Arbor, told Reuters Health by email. “The policy encourages shorter visits, which is not what most patients desire.”
Current payments range from $45-$211 for levels 2 to 5. The proposed change would allow payments of $93 for return visits and $135 for new patients for an E/M level that collapses the previous levels 2 to 5.
Dr. Callaghan and colleagues used the 2013 Medicare Physician and Other Supplier File to compare the current billing levels across specialties and to estimate the financial impact of the proposed changes.
The proportion of outpatient E/M codes billed at levels 4 to 5 ranged from a high of 70% for neurologists to a low of 11% for dermatologists, the team reports in JAMA Neurology, online October 31.
Other high users included cardiologists (65%) and other medical specialists (61%), and other low users included orthopedists (22%) and otolaryngologists (25%).
Medicare payments for physician outpatient E/M codes represented a median 50% of neurologists’ income. The proportions were higher for general/family practitioners (median, 87%) and obstetrician-gynecologists (median, 64%) and lower for ophthalmologists (median, 6%), cardiologists (median, 31%) and other medical specialties (32%).
Based on these data, the typical neurologist would lose a median $3,226 under the proposed system. Other losers under the new system would include cardiologists (median, $3,203 loss) and other medical specialists (median, $978 loss).
On the other hand, dermatologists would gain a median $16,655, otolaryngologists would gain $6,619 and orthopedists $6,239 under the proposal.
“The new policy incentivizes taking care of less complicated patients and having short visits, which is the opposite of what we should be incentivizing,” Dr. Callaghan said. “Specialists that earn money through outpatient visits and not procedures are most at risk.”
“The goal of the policy is to reduce documentation and auditing burden,” he said, “but this could be accomplished in other ways, such as by auditing by length of visit.”
- Callaghan BC, Burke JF, Skolarus LE, et al. Assessment of Proposed Changes to Evaluation and Management Billing Levels by Physician Specialty. JAMA Neurol. 2018 Oct 31. [Epub ahead of print]