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Physicians Tell Congress that Changes to Medicare Payments are Critical to Primary Care

Washington, DC (November 20, 2020) — In a letter to congressional leadership the American College of Physicians (ACP), along with other physician groups, asked Congress to ensure that essential changes to Medicare payments scheduled to go into effect Jan. 1 are implemented as planned. In addition to ACP, the letter was signed by American Academy of Family Physicians, American Academy of Allergy, Asthma & Immunology, American Academy of Home Care Medicine, American Academy of Neurology, American College of Rheumatology, American Medical Society for Sports Medicine, American Thoracic Society, Endocrine Society, North American Neuro-Ophthalmology Society, and Society of General Internal Medicine.

The changes to Medicare payments for office visits and other related evaluation and management (E/M) services, including the GPC1X code for complex visits, are included in the proposed Medicare Physician Fee Schedule for 2021.

“These payment increases are critical to primary care physicians, whose practices have been hit especially hard by the COVID-19 pandemic,” said Jacqueline W. Fincher, MD, MACP, president, ACP. “These payment increases will be critical to many practices continuing to operate and provide frontline care in their communities.”

In the letter the physician groups noted that they support a temporary, time-limited policy to ensure that no physician services receive reduced payments due to application of budget neutrality by the Centers for Medicare and Medicaid Services (CMS) to the Medicare Physician Fee Schedule Final Rule, consistent with the recommendations below to ensure fairness and accuracy in payments.

“Our organizations represent hundreds of thousands of physicians who are serving on the frontlines of a worsening public health crisis due to the COVID-19 pandemic.  Our members provide primary, comprehensive, preventive and complex care to millions of Medicare patients, including patients who are at high-risk or are currently suffering from severe COVID-19 disease,” wrote the groups in the letter.  “They also provide preventive health services and treat the many millions of Medicare patients with other health conditions, including patients with multiple chronic diseases.”

The letter then went on to outline four different priorities for any congressional legislation that addresses physician payments:

  • The previously finalized increases in relative values and payment rates for outpatient E/M codes, as outlined in the Medicare Physician Fee Schedule, must be allowed by Congress to go fully into effect on Jan. 1 without any delay, phase-in, or transition.
  • The G code for complex office visits, GPC1X, as previously finalized in the Medicare Physician Fee Schedule, also must be allowed by Congress to go fully into effect on Jan. 1.
  • Legislation to alleviate the impact of budget neutrality requirements as physicians respond to the COVID-19 pandemic should provide equitable relief across services and specialties.
  • A one-year waiver of budget neutrality adjustments under the Medicare Physician Fee Schedule. Limiting this “hold harmless” approach to a period of one year would give the new 117th Congress the time needed to decide on a policy that ensures that all services are treated equitably in 2022, including E/M services in physician offices, hospitals, nursing home, and long-term care facilities.

The full letter can be found online.

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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