Medicare Postpones Changes in Pay for Patient Evaluation and Management Services

ACP intends to keep working with agency to make sure payments reflect the value of complex care

Nov. 16, 2018 (ACP) – The American College of Physicians is pleased that the Centers for Medicare and Medicaid Services (CMS) responded to many of its concerns as the agency finalized changes to evaluation and management (E/M) fees for the year 2019.

“The finalized Medicare Physician Fee Schedule for 2019, including E/M fees, has some positive features,” said Shari Erickson, ACP's vice president for governmental affairs and medical practice. “It seems that CMS is listening to ACP recommendations.”

However, although CMS is not making changes to the fees now, ACP remains concerned about changes that the agency hopes to make in the years ahead.

“Internists appreciate CMS's decision not to finalize changes in payments for E/M services until 2021,” said Dr. Ana María López, ACP's president. “We are pleased that CMS will be moving forward with plans to simplify documentation for such visits, with improvements going into effect next year, and with additional streamlined documentation options becoming available later.”

One change that is being made in 2019 is that physicians will no longer need to re-document information – such as a patient's chief complaint – that had earlier been entered by staff or a beneficiary. This allows physicians to focus on what's important: how a patient's situation has changed or not changed since the last visit.

“This way, physicians can focus on documenting what they feel is relevant instead of re-documenting everything in a patient's history,” Erickson said.

As a whole, “CMS made some changes that are a good step in the right direction to address the concerns we raised,” she said. “They expressed a real willingness to have a conversation with us and other stakeholders to make improvements to their original proposal.”

Looking ahead, that conversation is likely to focus on how the agency plans to revise E/M fees in 2021. EM Payment Chart-Updated.pdf At that time, CMS expects to pay the same flat amount of reimbursement for office visits at levels 2, 3, and 4. Level 5 visits would continue to get a higher payment, recognizing the greater work involved in caring for the sickest patients.

ACP is pleased that CMS has abandoned plans to pay all levels at the same flat amount, a decision it says would have devalued the most complicated kinds of care. But “we have reservations about paying level 4 visits, the second most complex visits, at the same amount as levels 2 and 3 visits,” López said. “We look forward to working with CMS on developing, piloting, and evaluating approaches that recognize the value of complex, cognitive care.”

Erickson put ACP's plans for the future this way: “I would hope that we can actively work with CMS to come up with an approach that would appropriately pay for E/M services while also allowing for more comprehensive improvement in documentation.”

The good news, she said, “is that CMS expressed a real willingness to have a conversation with us and other stakeholders to make improvements.”

“We look forward to more improvements that will make a difference to the work lives of physicians,” said Erickson.

More Information

More on the 2019 Physician Fee Schedule, as well as changes to the Quality Payment Program, will be detailed in the next ACP Advocate, on Dec.7.

Back to the November 16, 2018 issue of ACP Advocate