Letter to CMS on E/M code consolidation

Dear Colleague,

We write to request your support for a letter to the Centers for Medicare & Medicaid Services (CMS) regarding the recently released proposed rule for the Medicare 2019 Physician Fee Schedule (PFS). As part of the agency’s laudable goal to substantially reduce administrative burdens on providers, the proposed rule includes a concerning provision that would significantly alter the evaluation and management (E/M) codes payment rates.

Currently, the E/M codes range from levels 1 to 5. Level 1 corresponds to less complex, non-physician services, while Level 5 payment rates correspond to more complex physician services. However, in an effort to decrease paperwork, the agency is proposing a consolidation of the E/M codes from five levels to two levels. This proposal devalues the expertise, clinical decision-making, and time of physicians who treat patients with more complex conditions.

Additionally, while consolidating these codes will reduce the administrative burden for some clinicians, creating add-on codes will increase cumbersome paperwork for physicians who treat more complex patients. This will ultimately defeat the initial goal of the consolidation. Further, it is concerning that the proposal also includes a separate set of E/M codes for podiatrists, which would create different valuation of services based on physician specialty. This is expressly prohibited under the Social Security Act Section 1848(c)(6) and would also reduce reimbursement rates for podiatrists.

Finally, the rule proposes an implementation date of January 1, 2019, which is unlikely to provide physicians with the necessary time to adjust their administrative practices to comply.

If finalized, the 2019 PFS proposed rule would adversely impact a wide range of physician specialties and their patients. Given these concerns, we hope you will join us on the letter, below, urging CMS spend more time working closely with physicians and other stakeholders in order to identify alternative methods to reimburse physicians at appropriate rates.

Staff Contacts:
Greg Brooks, Greg.Brooks@mail.house.gov (Wenstrup)
Frannie Einterz, Frannie.Einterz@mail.house.gov (Matsui)
Kristen Donheffner, Kristen.Donheffner@mail.house.gov (Blumenauer)
Meghan Stringer, Meghan.Stringer@mail.house.gov (Blackburn)

Rep. Marsha Blackburn
Rep. Earl Blumenauer
Rep. Doris Matsui
Rep. Brad Wenstrup

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[Date], 2018

The Honorable Seema Verma
Centers for Medicare & Medicaid Services
U.S. Department of Health and Human Services
7500 Security Boulevard
Baltimore, MD 21244

Dear Administrator Verma:

We write to express our concerns regarding a proposed plan by the Centers for Medicare & Medicaid Services (CMS) in the Medicare 2019 Physician Fee Schedule proposed rule to consolidate evaluation and management services. We commend the agency’s goal and efforts to reduce paperwork and unnecessary administrative tasks, as well as associated provider burdens, including proposals to reduce the required patient history documentation, eliminate requirements for physicians to re-document certain information, and eliminate the need to justify a home visit.

Specifically, we are concerned that the proposal to consolidate these services devalues the expertise, clinical decision-making, and time of physicians who treat patients with complex conditions such as cancer, rheumatoid arthritis, diabetes, multiple sclerosis, Crohn’s disease, macular degeneration, ALs, hypertension, infection diseases, primary immunodeficiency diseases and many others. We are also concerned that the negative impact is likely to be large for faculty physicians at the nation’s major teaching hospitals who treat a disproportionate share of these complex patients. While consolidating these codes could reduce paperwork for some physicians, the creation of the add-on codes would also create a new and significant paperwork requirement for physicians such as oncologists, rheumatologists, ophthalmologists, neurologists, endocrinologists and other specialists, who treat more complex patients, which will undermine the underlying, positive intent of the proposed rule to reduce administrative burden on clinicians.

While the consolidation of payment rates for evaluation and management levels 2 through 5 is of significant concern to us, we are also troubled that the proposed rule singles out podiatric physicians, proposing that podiatrists use a separate set of evaluation and management codes, for reduced reimbursement. Podiatric physicians are classified as physicians under Medicare and they provide the same evaluation and management services that their allopathic and osteopathic colleagues do. Under the Social Security Act Section 1848(c)(6), differential valuation (and thereby payment) of services paid under the Physician Fee Schedule based on physician specialty is expressly prohibited.

Additionally, it is our understanding that this proposal was created with little consultation with affected stakeholders, and we have heard significant concerns from constituent physicians of all specialties who are concerned with the potential effects this proposal may have on their patients and practices. They have also expressed concern that the proposed implementation date of January 1, 2019 does not provide them the necessary time to adjust their administrative practices to comply.

We appreciate and commend the good intentions behind this proposal, to reduce paperwork and administrative burden, we urge the agency to take additional time to work closely with physicians and other stakeholders to identify alternative approaches that would accomplish CMS’ goals while ensuring that physicians are reimbursed appropriately according to the level of care required by each individual patient’s condition.


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