ACP: Improvements in Proposed Medicare Physician Fee Schedule Will Benefit Physician Practices in Long Term

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ACP continuing advocacy to ensure the proposed fee schedule increases are implemented, that telephone and telehealth visits are covered

Aug. 14, 2020 (ACP) – The Centers for Medicare & Medicaid Services (CMS) has released its proposed Medicare Physician Fee Schedule for 2021. The American College of Physicians is pleased by the beneficial changes but will continue to advocate for long-term reform in areas like telehealth.

“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,” said Brian Outland, ACP director of regulatory affairs. “However, there's more work to be done. ACP will continue to focus on ensuring that CMS implements the fee schedule increases for office visits in January 2021 as planned and is asking that CMS continue coverage and payment for telephone and telehealth visits.”

CMS released the proposed 2021 fee schedule on Aug. 3, four weeks later than usual. The delay was unexplained. Still, Outland said, “we will proceed as usual with examining the proposed rule, providing our membership with an analysis of the impacts on internists and advocating for policies that are in the interest of internists and subspecialists.”

Once finalized, the fee schedule will set payment policies, payment rates and other regulations for services provided as of Jan. 1, 2021.

ACP is especially pleased that CMS is moving forward in this proposed rule with the increases in relative value units (RVUs). “Medicare has long undervalued office visit services provided by internal medicine and other cognitive and primary care physicians,” Outland said, “and CMS's decision to move forward with higher RVUs for outpatient evaluation/management (E/M) services is a major step toward recognizing the importance of these services to our patients. 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.”

ACP took part in a multidisciplinary advisory process via the RVS Update Committee. “We helped spearhead the effort to provide evidence in support of the recommended increases,” Outland said. “ACP stayed in close communications with CMS and offered to provide any assistance the College could provide in working toward the implementation of these changes.”

ACP is concerned, however, about the potential for lower payments for certain physicians. Outland explained 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 typically required by Medicare statute. Although overall payments will improve for many physicians and specialties that provide primarily undervalued E/M services, some physicians and specialties will see reductions. “ACP is supportive of requests to Congress to waive budget neutrality for the 2021 Medicare fee schedule RVU increases,” Outland said, “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.”

ACP is also urging CMS to permanently cover telephone E/M services and not end these payments after the public emergency is over. “While CMS has not proposed to do that in this proposed rule, ACP will be providing comments and encouraging the agency to continue coverage and payment for these services, as the pandemic has proven that they have become a vital component in care delivery,” Outland said.

Moving forward, comments on the proposed fee schedule are due in early October. “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,” Dr. Jacqueline W. Fincher, ACP president, said in a statement. “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.”

CMS is expected to release final policies in November or December before they take effect at the beginning of 2021.

More Information

More detail on the proposed Medicare Physician Fee Schedule for 2021 is available in a fact sheet prepared by CMS.

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