The Centers for Medicare & Medicaid Services (CMS) asked for comments on its proposed physician fee schedule and boy, oh boy, did it get them: 15,314 of them.
As the comment period ended at 5 p.m. yesterday on the government proposal, CMS got pages and pages of reaction, including a strong call from many for the agency to abandon a controversial proposal to consolidate evaluation and management (E/M) billing codes because of fears it will leave physicians who treat high-acuity patients underpaid.
While CMS proposed the change to streamline documentation and give doctors more time with patients, one physician group said the result would be paying doctors the same amount for office visits to evaluate patients with a case of sniffles as those for complex brain cancer.
In a 136-page letter, the American Medical Association, the country’s largest physician group, asked CMS to delay action on the proposed code change to allow a work group to develop an alternative by 2020. “The proposed restructuring has generated a groundswell of opposition from individual physicians and nearly every physician and health professional organization in the country, including those whose members are projected to see increases in their Medicare payments,” wrote James L. Madara, M.D., the AMA’s executive vice president and CEO.
A bipartisan group of 90 lawmakers also sent a letter to CMS on Friday urging the agency not to implement the change. "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," the members of Congress wrote.
The plan would collapse payment rates for eight office visit services for new and established patients down to two each. Doctors also offered comments. “This is a ridiculous proposal that will only be a detriment to patients and providers alike,” said one anonymous commenter.
A geriatrician who cares for patients with multiple, complicated medical issues said he could see no benefit from the proposal. “It does not make sense to assign the same payment for both a 15-minute visit for a 20-year-old with no known issues and no complaints and for a 40-minute visit for an 80-year-old with a multitude of acute and chronic illnesses,” he wrote.
CMS issued the proposed rule in July to update the Medicare physician fee schedule and outline changes for year three of the physician payment program implemented under MACRA. CMS is now expected to review the comments and will issue a final rule this fall.