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Final 2020 Medicare Physician Fee Schedule Includes Wins for Primary and Cognitive Care

Advocate Masthead

ACP urges members of Congress to provide support

Dec. 6, 2019 (ACP) – In a major victory for patients and physicians, the federal government has dramatically overhauled reimbursement and documentation requirements for evaluation and management (E/M) codes. But the American College of Physicians still has more work to do to make sure the reforms included in the final 2020 Medicare Physician Fee Schedule stay in place.

“Our push for beneficial change has been a great success, and it's a testament to our position as a trusted and influential voice in the nation's capital,” said Dr. Robert McLean, president of ACP. “The significance of these new policies cannot be overstated. The newly approved Physician Fee Schedule will greatly improve payments for the types of office visits performed by internists and medical subspecialists. And it will reduce the time physicians must spend on unnecessary documentation.”

Earlier this year, ACP responded to the proposed 2020 fee schedule with a 60-page letter outlining its recommendations. ACP supported many aspects of the proposed fee schedule that made it into the final version that was released in November 2019 by the Centers for Medicare & Medicaid Services.

ACP is pleased that the final fee schedule will overhaul value and reimbursement for office and outpatient visits for 2021 based on a multispecialty advisory process. ACP is especially enthusiastic about the following provisions:

  • Higher physician work and practice expense relative value units (RVUs) for new and established office visit codes. These changes will lead to increased payments and reform a system that undervalues the complexity of physician work in providing primary and cognitive care to patients.
  • A visit complexity add-on code. This code will allow eligible primary care physicians, including internists, to receive additional compensation for their office visits, above and beyond the higher payments that will result from increases in the work and practice expense RVUs.
  • Reduced documentation requirements for office visit codes. This change will enable physicians to provide documentation for each visit based on medical decision-making or total time.
  • Expanded and improved payment for care management services. Appropriate payment for care management will make it possible for physicians to receive proper reimbursement for care coordination.

Altogether, it is estimated that these changes will shift approximately $7 billion to primary and cognitive care services and the physicians that perform and bill for them. The implementation of these changes will increase some physicians' payments while reducing others. This is because changes to the fee schedule must be “budget-neutral,” meaning they cannot cause overall spending to rise.

As a result, McLean said, medical organizations whose members face lower payments may push back against the changes scheduled to be implemented in 2021. “It's not surprising then, that some are urging Congress to block or take other actions to undermine the gains for primary and cognitive care, and to reduce the losses to their specialties,” he said.

ACP is gearing up to advocate for the new policies and convince lawmakers to keep them in place. In November, ACP urged the leaders of several congressional committees to support the changes.

“Medicare has long undervalued E/M codes (office visits) by internal medicine physicians, family physicians, and other cognitive and primary care physicians,” McLean writes in the letters. “At the same time, physicians have been faced with excessive documentation requirements to be paid for such services. The direct result of that has been fewer physicians going into office-based internal medicine and other primary care and mostly cognitive disciplines.”

The new policies, McLean said, will help reverse this trend. “Patients will benefit from physicians spending more time with them,” he said, “and from the better outcomes and lower costs associated with having access to primary and cognitive care physicians.”

ACP has activated its grassroots advocacy program and is urging members to contact their congressional representatives to support these improvements. ACP has also joined with other organizations representing internal medicine subspecialties and primary care in urging Congress to support the final rule.

More Information

An ACP Action Alert to urge members of Congress to support evaluation and management code wins in the final fee schedule is available on the ACP website.

Letters that ACP sent on its own and in collaboration with other allied groups to urge Congress to support the evaluation and management code wins are also on the ACP website.

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Back to the December 6, 2019 issue of ACP Advocate