CMS sticks with E/M pay plan over some objections

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Measuring the cost of the new Medicare physician fee schedule for GIs 

We all agree that E/M services have been undercompensated for many years and applaud CMS for increasing their reimbursements, but this does not mean that endoscopic services are suddenly less valuable as a result. Nor does it mean that the work required to perform endoscopic services has declined.

Dr. Lawrence R. Kosinski

Unfortunately, implementation of the new Medicare physician fee schedule in the proposed rule will result in a 10% decline in the reimbursement for both upper and lower endoscopies. Although rises in E/M services will negate half of this loss, gastroenterologists will still be faced with a 5% net decline in professional reimbursement. Since we all have different combinations of CPT codes, the American Gastroenterological Association has developed an MPFS 2021 Proposed Rule Impact Calculator, which will allow you to calculate how this proposed MPFS will impact your practice. We all must speak out against these unacceptable declines in endoscopic reimbursements both through our societies and individually. AGA has a campaign on budget neutrality (https://gastro.quorum.us/campaign/28353/)

Lawrence R. Kosinski, MD, MBA, AGAF, is the chief medical officer at SonarMD, Chicago. He is also an associate editor for GI & Hepatology News.


The Trump administration is sticking with a plan to boost certain Medicare pay for many primary care and other specialties focused heavily on office visits while lowering that for other groups to balance these increased costs.

On Aug. 4, the Centers for Medicare & Medicaid Services posted on the Federal Register draft versions of two of its major annual payment measures: the physician fee schedule and the payment rule for hospital outpatient and ambulatory surgery center services. On Aug. 3, the CMS informally posted a copy of the physician fee schedule on its own website, allowing medical groups to begin reading the more than 1,300-page rule.

Federal officials normally use annual Medicare payment rules to make many revisions to policies as well as adjust reimbursement.

The draft 2021 physician fee schedule, for example, calls for broadening the authority of clinicians other than physicians to authorize testing of people enrolled in Medicare.

The CMS intends to allow nurse practitioners, physician assistants, and certain other health care professionals to more widely supervise diagnostic psychological and neuropsychological tests.

The draft 2021 hospital outpatient rule proposes a gradual changeover to allow more procedures to be performed on an outpatient basis. This shift could save money for Medicare as well as for the people enrolled in the giant federal health program who need these services, the CMS explained.

Medicare would begin with a change in status for almost 300 musculoskeletal-related services, making them eligible for payment in the hospital outpatient setting when appropriate, CMS wrote in a fact sheet.

The initial reaction to Medicare’s proposed 2021 rules centered on its planned redistribution of funds among medical specialties. The CMS had outlined this plan last year. It is part of longstanding efforts to boost pay for primary care specialists and other physicians whose practice centers more around office visits than procedures.

There is broad support in health policy circles for raising pay for these specialties, but there also are strong objections to the cuts the CMS plans to offset the cost of rising pay for some fields.

Susan R. Bailey, MD, president of the American Medical Association, addressed both of these ideas in an AMA news release on the proposed 2021 physician fee schedule. The increase in pay for office visits, covered under evaluation and management services (E/M), stems from recommendations on resource costs from the AMA/Specialty Society RVS Update Committee, Dr. Bailey said.

“Unfortunately, these office visit payment increases, and a multitude of other new CMS proposed payment increases, are required by statute to be offset by payment reductions to other services, through an unsustainable reduction of nearly 11% to the Medicare conversion factor,” Dr. Bailey explained.

In the news release, Dr. Bailey asked Congress to waive Medicare’s budget-neutrality requirements to allow increases without the cuts.

“Physicians are already experiencing substantial economic hardships due to COVID-19, so these pay cuts could not come at a worse time,” she said.

Winners and losers

The CMS details the possible winners and losers in its payment reshuffle in Table 90 of the proposed 2021 physician fee schedule. In the proposed rule, CMS notes in the draft that these figures are based upon estimates of aggregate allowed charges across all services furnished by physicians and other clinicians.


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