Policy & Regulation News

Experts State 2019 Physician Fee Schedule Harms Patient Care Access

MGMA and the American College of Rheumatology issued statements asserting that the CMS Physician Fee Schedule would cut patient care access.

physician fee schedule patient care access

Source: Thinkstock

By Sara Heath

- More healthcare industry leaders are expressing concerns over provisions included in the 2019 proposed Physician Fee Schedule, specifically stating that statutes to reduce reimbursement for evaluation and management (E/M) services could considerably hamper patient care access.

Both the Medical Group Management Association (MGMA) and the American College of Rheumatology (ACR) have issued statements asserting that limiting reimbursements for E/M services would reduce providers’ abilities to treat patients, both organizations wrote in separate letters to CMS.

The CMS proposal calls for a flat fee for E/M services, regardless of patient complexity. Providers would also see relaxed E/M reporting requirements that would ideally cut provider reporting burden.

However, ACR says such cuts and resultant flat payments would hinder specialty providers and potentially dissuade medical students considering practice in a complex, specialty field.

“While we applaud CMS for taking steps to reduce provider documentation and reporting burdens, we have serious concerns about the impact these cuts will have on patient access to rheumatology care,” said David Daikh, MD, PhD, President of the ACR.

“A one-size-fits-all approach to reimbursement is not the way to move forward, and cuts of this magnitude will not only force physicians to spend less time with patients but could also dissuade medical students from pursuing careers in rheumatology and other specialties that treat a high volume of patients with complex needs,” Daikh added.

ACR recommends CMS continue with the documentation flexibility, which would result in reduced provider reporting burden. However, the organization says CMS should not follow through with payment changes, lest those changes negatively impact patient care access.

MGMA echoed those sentiments in its own comments letter.

“Reconsider options for reducing documentation associated with E/M office visits without harming physician practices that treat the sickest patients,” MGMA suggested to CMS. “We urge CMS not to move forward with its proposal to collapse payment rates for eight office visits for new and established patients down to two each as there are many unanswered questions and potential unintended consequences that would result.”

Other industry leaders also called on CMS to reconsider streamlining E/M payments. American Medical Association (AMA) and 160 of its peers previously stated that these changes will negatively impact patients.

“We oppose the implementation of this proposal because it could hurt physicians and other health care professionals in specialties that treat the sickest patients, as well as those who provide comprehensive primary care, ultimately jeopardizing patients’ access to care,” the group wrote.

AMA, like MGMA and ACR, did concede that streamlining the E/M services reporting requirements was essential for cutting provider workload.

“Excessive E/M documentation requirements do not just take time away from patient care; they also make it more difficult to locate medical information in patients’ records that is necessary to provide high quality care,” AMA and its colleagues explained. “Physicians and other health care professionals are extremely frustrated by ‘note bloat,’ with pages and pages of redundant information that makes it difficult to quickly find important information about the patient’s present illness or most recent test results.”

E/M services changes are not the only policies that received a facelift in the CMS proposed Physician Fee Schedule. CMS also tucked away provisions to increase funding for mHealth and telehealth services under Medicare, a move which MGMA favored.

“Promote access to care by providing reimbursement for communications-based technology and telehealth services,” MGMA wrote. “CMS should modernize the Medicare program by finalizing coverage for virtual care, interprofessional consultation, and remote patient monitoring services. To facilitate widespread adoption of new non-face-to-face services, CMS should permit practices the flexibility to implement any new covered codes in a manner that best fits their practice and avoid overly restrictive billing requirements.”


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