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Internists Say Medicare’s Changes to Payments for Office Visits Will Help Physicians and Practices

Washington, DC (August 4, 2020) —The American College of Physicians (ACP) strongly supports the Centers for Medicare and Medicaid Services (CMS) moving forward with changes to Medicare payments to physicians to better recognize the value of cognitive services in providing quality care to patients.  The proposed Medicare Physician Fee Schedule for 2021, which was released by CMS on Aug. 3, ensures that CMS’s decision, made last year, to implement new and improved payment rates for Evaluation and Management (E/M) services will go into effect on Jan. 1, 2021 as planned and finalized by the agency.

These changes in the work relative value units (RVUs) for outpatient E/M services reflected recommendations from a multi-disciplinary advisory process, the RVS Update Committee (RUC), which ACP participated in and helped spearhead the effort to provide evidence in support of the recommended increases to the RUC and CMS.

“Medicare has long undervalued office visit services provided by internal medicine and other cognitive and primary care physicians, and CMS’s decision to move forward with higher payments for E/M services is a major step toward recognizing the importance of these services to our patients,” said Jacqueline W. Fincher, MD, MACP, president, ACP.  “These changes are especially important at a time when many primary care practices in particular are under severe financial stress due to the COVID-19 pandemic and are at risk of closing their doors.”

ACP notes that CMS applied a budget neutrality adjustment to the fee schedule to offset the increase in total spending that would have resulted from the changes in the RVUs for E/M and other services, as generally required by Medicare statute.  While many physicians and specialties providing primarily undervalued E/M services will see major improvements in overall payments even with the budget neutrality adjustment, some will see reductions.  ACP is supportive of requests to Congress to waive budget neutrality for the 2021 Medicare Fee Schedule RVU increases, provided that this would not result in a delay or in any way undermine CMS’s decision to fully implement the E/M increases and other improvements on Jan. 1, 2021.  

In addition to the changes to payments for E/M services, ACP also noted several other positive changes in the 2021 Fee Schedule, including:

  • A new prolonged service code that would allow physicians to account for visits that take an extended amount of time.
  • A new code, GPC1X, to allow for higher payment for certain visit complexities inherent to some evaluation and management services.
  • Increased payments for transitional care management services, recognizing that good transitional care management is associated with reduced readmission rates, lower mortality, and lower healthcare costs.
  • Additional services on the list of those that can be provided by telehealth.  This is important as our country continues to deal with the COVID-19 public health emergency.
  • Allowing direct-supervision of practitioners unable to bill Medicare directly for procedures to be provided using audio and video technology through Dec. 31, 2021, better allowing the system to accommodate the challenges presented by the COVID-19 pandemic.
  • Proposing a significant revaluation of immunization administration codes. ACP has previously raised this as an issue and is glad CMS has heard our concerns about access to immunizations.

“The improvements that CMS has included in the proposed fee schedule for 2021 will go a long way to help physician practices next year and in the future.  However, more still needs to be done to support physician practices, particularly primary care practices, to weather the COVID-19 pandemic,” continued Dr. Fincher. “We will be continuing to analyze the proposed rule and communicating with CMS about what more should be done to help internal medicine physicians and their patients.”

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About the American College of Physicians
The American College of Physicians is the largest medical specialty organization in the United States with members in more than 145 countries worldwide. ACP membership includes 163,000 internal medicine physicians (internists), related subspecialists, and medical students. Internal medicine physicians are specialists who apply scientific knowledge and clinical expertise to the diagnosis, treatment, and compassionate care of adults across the spectrum from health to complex illness. Follow ACP on Twitter, Facebook, and Instagram.

Contact:    Jacquelyn Blaser, (202) 261-4572, jblaser@acponline.org