The Medicare Payment Advisory Commission (MedPAC) has raised concerns regarding the proposed changes to the Physician Fee Schedule (PFS) and other components of Medicare Part B
MedPAC Chairman Francis Crosson, M.D., told Andy Slavitt, acting commissioner of the Centers for Medicare & Medicaid Services (CMS), in a Sept. 8 letter, that he was particularly worried about the continued reliance on evaluation & management (E&M) codes. Crosson noted that the E&M codes "may not reflect all the services and resources involved with furnishing certain kinds of care, particularly ongoing, comprehensive, coordinated care management for a panel of patients."
Instead, MedPAC recommends that there be an additional payment for primary care, as well as a code for for chronic care management.
But the agency was against boosting chronic care payments to rural clinics and federally qualified health clinics, which was contained in the CMS recommendations. He noted that there is likely enough of a revenue stream to clinics in this area already in the form of bundled payments.
Crosson also noted that the payment system continues to favor medical specialties over primary care, with large disparities in income for surgeons versus primary care doctors.
However, MedPAC did show its support for payments to physicians to discuss end-of-life care with aging patients. Medicare had in the past allowed enrollees to have advanced care planning services, but physicians had not been paid to furnish them.
The agency primarily reserved its comments regarding the Physician Quality Reporting System and the Merit-Based Incentive Payment System, but asked whether the bonus payments are high enough to move physicians out of the fee-for-service environment.
CMS issued the proposed changes to the PFS in mid-July, and the public comment period will conclude next month.
To learn more:
- read the MedPAC letter here (.pdf)