Thursday Mar 21, 2013

Making the Case for Primary Care-specific Codes

The evaluation and management (E/M) services provided by primary care physicians are more complex, and thus more intense, than those of our subspecialist colleagues. Unfortunately, existing E/M codes do not reflect the scope of our responsibilities, the comorbidities of our patients, the complexity of their care or the coordination that care requires.

They should, and Academy leaders and staff made those points recently during a meeting with CMS officials who are involved in the development of the 2014 Medicare Physician Fee Schedule. We presented them with data that demonstrates how primary care E/M services are different and why they should be valued differently than services provided by other specialties.

Let's backtrack a bit.

A year ago, the AAFP Board of Directors made the difficult decision to stay involved with the AMA/Specialty Society Relative Value Scale Update Committee (RUC), despite the fact that the committee has undervalued primary care services in its recommendations to CMS. The Academy took a stance that it would participate in the RUC process while also advocating directly with CMS

Around the same time, the AAFP's Primary Care Valuation Task Force made recommendations that included creating primary care-specific E/M codes and valuing primary care E/M services differently than those provided by subspecialists.

I told you in October that the Academy was working with a consulting firm to collect and aggregate data to support our argument about E/M codes. During a March 7 meeting with CMS, we presented the agency with preliminary data from that in-depth research.

Although CMS officials cannot comment on the process during the development of next year's Medicare Physician Fee Schedule, they can ask questions and request more information. When you are asking someone for more money, you can expect questions. We answered a lot of questions.

CMS officials also indicated they were eager to see more data supporting our position.

A draft of the fee schedule is expected in July before a final version is published in November. That gives us some time to continue our efforts and push forward with our request for a coding system that fairly values the important work we perform in the care of our patients.

Glen Stream, M.D., M.B.I., is board chair of the AAFP.

Comments:

I just spent almost two hours reviewing, annotating, and following up on notes, letters, labs, and scans performed by subspecialists that my patients see: this is typical of the work family physicians are expected to perform that is not covered by the current E&M codes. The AAFP is to be congratulated on this move. The proposal is clear, simple, and directly addresses the most pressing problem facing our specialty. Bravo! (Aside: didn't CMS basically ignore a similar proposal last year? I hope the AAFP leadership has a well-thought out negociating strategy to deal with the possible responses from CMS.)

Posted by Donald Brown on March 22, 2013 at 03:12 PM CDT #

Honestly, if past experience is any indication these "Primary Care specific E/M Codes" are more likely to be used to pay us less rather than to accurately value our services. I, also, congratulate the AAFP on addressing this issue but I also hope that they have, as Donald says, a well defined negotiating strategy. The AAFP leadership show keep in mind that the Membership is NOT impressed with its past record of supporting our interests and act accordingly. Donald, don't forget the avalanche of FMLA, AFLAC, and other forms that the specialists tell the patient to take to their PCP for completion, even when they involve services or procedures the specialist performed.

Posted by James Biggerstaff on March 28, 2013 at 03:50 AM CDT #

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