ACP commends CMS proposals to increase values assigned to evaluation and management codes

June 22, 2006

Washington -- The American College of Physicians (ACP) today commended the Centers for Medicare and Medicaid Services (CMS) on its Wednesday, June 21st proposal to increase the work relative value units (RVUs) assigned to the Medicare Evaluation and Management (E/M) codes.

"There's no doubt that these work RVU increases are appropriate and necessary," said J. Leonard Lichtenfeld, MD, FACP, the ACP representative to the Relative Value Scale Update Committee (RUC) - an entity that makes recommendations to CMS on relative values. "The physician work involved in furnishing these services has increased significantly in the last 10 years."

Medicare law requires CMS to assess the accuracy of the relative values it assigns to physician services every five years. CMS last changed the work RVUs assigned to the E/M services in 1997. ACP, recognizing that many E/M services were valued too low because of changes in patient characteristics and physician practice, asked CMS in Jan. 2005 to include the E/M codes in this "Five-Year Review." The College was joined in its request by internal medicine subspecialty groups and other organizations that represent cognitive-oriented physicians. CMS agreed, incorporating the following codes in the Five-Year Review:

New patient office visits Established patient office visits
Initial hospital care services Subsequent hospital care services
Hospital discharge services Office consultations
Inpatient consultations Emergency department services
Critical care services

CMS then asked the RUC, made up of physicians appointed by major specialty organizations, to make a recommendation on the appropriate work RVU for the E/M and the other services the agency included in the Five-Year Review. The ACP-led coalition worked with the RUC for about a year - considering national survey data and other information compiled by government and physician-specialty organizations - to determine the appropriate work RVUs for these E/M services. The CMS proposal adopts the E/M recommendations made by the RUC.

"ACP commends CMS for accepting the RUC recommendations," Dr. Lichtenfeld said. "The fact that these recommendations were supported by at least two-thirds of the RUC members shows that the physician community recognizes that these changes are warranted. ACP also believes that the CMS-proposed changes are not only warranted by the evidence, but are essential to at least begin to address other factors at play in our healthcare system, especially the disturbing trend that significantly fewer physicians-in-training are entering into primary care."

"ACP has determined that inadequate and dysfunctional payment policies, including the undervaluation of E/M services, combined with high levels of medical student debt, are key drivers behind the impending collapse of primary care," Dr. Kirk emphasized. "Medicare, as the single largest purchaser of health care in the United States, can lead by replacing policies that are antithetical to primary care with ones designed to encourage and support its importance and growth."

The Medicare law requires that CMS offset the increased Medicare spending resulting from relative value increases, which CMS proposes to do by applying a special adjustment factor that will fully offset the costs associated with the work RVU increases. After the budget neutrality adjustment is applied, physicians who see the most Medicare patients in face-to-face E/M visits will experience significant increases in Medicare payments, while some physicians who provide fewer E/M services will experience payment reductions. Such redistribution will begin to correct long-standing reimbursement disparities that are contributing to the looming crisis in access to primary care and help ensure an adequate supply of internists and other physicians to care for an increasingly aging population.

"ACP encourages CMS to hold the line on its proposal at the end of the 60-day public comment period and include the proposed E/M work RVUs in the final fee schedule to be published by Nov. 1," Dr. Kirk concluded.
-end-
The American College of Physicians is the largest medical specialty organization and the second-largest physician group in the United States. ACP members include 119,000 internal medicine physicians (internists), related subspecialists, and medical students. Internists specialize in the prevention, detection and treatment of illness in adults.

American College of Physicians

Related Primary Care Articles from Brightsurf:

Six ways primary care "medical homes" are lowering health care spending
New analysis of 394 U.S. primary care practices identifies the aspects of care delivery that are associated with lower health care spending and lower utilization of emergency care and hospital admissions.

Continuity of English primary care has worsened with GP expansions
A new study published by the British Journal of General Practice has found that patients' abilities to see their preferred GP has fallen greater in English practices that have expanded, compared with those that stayed about the same size.

Primary care office-based vs telemedicine care visits during COVID-19 pandemic
This observational study quantified national changes in the volume, type and content of primary care delivered during the COVID-19 pandemic, especially with regard to office-based visits compared with telemedicine encounters.

Expenditures for primary care may affect how primary care is delivered
This study looks at trends in out-of-pocket and total visit expenditures for visits to primary care physicians.

Primary care clinicians drove increasing use of Medicare's chronic care management codes
To address the problem of care fragmentation for Medicare recipients with multiple chronic conditions, Medicare introduced Chronic Care Management (CCM) in 2015 to reimburse clinicians for care management and coordination.

Primary care at a crossroads: Experts call for change
Primary care providers have experienced a rise in responsibilities with little or no increase in the time they have to get it all done, or reduction in the number of patients assigned to them.

Primary care physicians during the COVID-19 epidemic
Scientists from the University of Geneva has analysed clinical data from more than 1,500 ambulatory patients tested for COVID-19.

The five phases of pandemic care for primary care
The authors present a roadmap for necessary primary care practice transformations to care for patients and communities during the COVID-19 pandemic.

Women almost twice as likely to choose primary care as men
Analysis of osteopathic medical school survey data reveals women are 1.75 times more likely to choose primary care than men, according to a study in The Journal of the American Osteopathic Association.

Spending on primary care vs. other US health care expenditures
National health care survey data were used to assess the amount of money spent on primary care relative to other areas of health care spending in the US from 2002 to 2016.

Read More: Primary Care News and Primary Care Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.