Citing the need to reduce paperwork hassles, officials at the Centers for Medicare & Medicaid Services are proposing to flatten the payment for evaluation and management (E/M) visits coded at levels 2-5.
The CMS outlined how the proposal would affect payment using 2018 rates to model the change. The proposal would set the payment rate for level 1 E/M office visits for new patients at $44, down from the $45 using the current methodology. Levels 2-5 would receive $135. Currently, payments for level 2 visits are set at $76, level 3 at $110, level 4 at $167, and level 5 at $211.
For office visits with established patients, the proposed rate would be $24, up from the current payment of $22 for a level 1 visit. Levels 2-5 would receive $93. Under the current methodology, payments for level 2 visits are set at $45, level 3 at $74, level 4 at $109, and level 5 at $148.
The change also comes with a reduced documentation burden, so the same documentation is needed regardless of which level between 2 and 5 the office visit is, a move that is expected to save time.
The CMS outlined its vision for changes to the E/M payment in the proposed update to the 2019 Medicare physician fee schedule. Comments on the proposal are due Sept. 10, 2018.
The agency estimated that for most specialties, there would be minimal effect on this proposed change. However, for 10 specialties, payment reductions could result from this change. The proposal is raising concerns, particularly from those who stand to see their pay reduced.
Seema Verma
CMS officials estimate the proposal would save time. CMS Administrator Seema Verma said that the documentation change would result in an additional 51 hours for patient care per clinician per year.
“The agency has clearly heard from physicians about the need to reduce administrative burdens for physicians,” stated Lisa Gangarosa, MD, AGAF, chair, AGA Government Affairs Committee. “In that regard, CMS should be commended. Unfortunately, in their efforts to reduce burden, CMS has proposed changes that drastically undervalue the care gastroenterologists and hepatologists provide to patients with inflammatory bowel disease, motility disorders, chronic liver disease and other complex gastrointestinal diseases.”
Angus B. Worthing, MD, chair of the American College of Rheumatology’s Committee on Government Affairs, said he was doubtful that any increase in volume would offset the losses from the proposed flat payment across levels 2-5 E/M visits, especially if the pay decrease results in access issues.
SOURCE: CMS proposed rule, CMS-1693-P.
