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Physician Fee Schedule Draws Mixed Reaction

Analysis  |  By Debra Shute  
   November 10, 2016

Groups representing primary care physicians welcome additional codes for chronic care management, but are concerned about administrative burden.

The Centers for Medicare & Medicaid Services 2017 Physician Fee Schedule, finalized last week, emphasizes support for primary care. However, the extent to which the new rules and codes will actually benefit primary care physicians depends on whom you ask.

The American College of Physicians has generally applauded CMS' final rule, while the American Academy of Family Physicians has expressed a degree of disappointment.

PFS Billing-Code Rules 'A Step Forward,' Says AOA

For deeper insight, Brian Outland, senior associate for regulatory affairs in ACP's department of health policy and regulatory affairs; and John Meigs, Jr., MD, FAAFP, president of the AAFP spoke with HealthLeaders Media about the rule. The following transcript has been edited.

HLM: What reactions have you heard from your members so far about the rule?

Outland: The final rule contains a lot of wins for the college and our members that we pushed for, so overall the feedback from members has been favorable.

We like seeing how CMS is continuing to support primary care and the efforts they're putting behind chronic care management (CCM). The codes that they have approved for primary care physicians, such as non-face-to-face prolonged service codes, will be very helpful because, as we've seen over the years, much of the work PCPs are doing is outside of the brick-and-mortar [office].

We're also happy to see some lightening of the burden for CCM.

Meigs: The general tone has been appreciation of the things that CMS has done, but in a lot of ways it's still an example of a good idea being diminished by government bureaucracy.

HLM: Do you expect that the CCM codes will be user-friendly enough for physicians to use?

Meigs: We're pleased with the addition of these codes, as they acknowledge the care that family physicians and primary care physicians provide, and that a lot of patients have very complex problems, which requires time and effort.

The fact that we no longer need the beneficiary to sign off and acknowledge that we've discussed [CCM] ahead of time takes one bureaucratic step out of the process, so we do expect some increase in use.

However, I don't think we're going to see a tremendous increase in use because the other requirements for documenting time, along with other complexities, remain in place.

Our biggest disappointment with CMS, however, is that they did not remove the copay for these essential services. That's the biggest thing that's going to get in the way.

Outland: We do expect more physicians to use the codes because, in addition to lightening the burden of them, CMS has also finalized paying for management of the complex chronic care patient.

But there's still a 40-minute gap between the non-complex patient and the complex that is not being covered by CMS, so we would like to see them go a step further and perhaps come up with an add-on code to the non-complex patient to cover that additional 40 minutes of time.

HLM: What advice do you have for your members?

Outland: Learn and actually use the new codes. As we continue to digest the information, we'll have further guidance on how internists can best do so.

Meigs: Become familiar with the new codes for CCM, cognitive evaluation, behavioral health, and so on. CMS is now paying for things that in the past [physicians] did for free.

CMS sure hasn't made getting those funds easy. The codes are complicated to use and it's a documentation nightmare. But if you have the systems in place to utilize the new codes, there's the availability of additional payment. 

Debra Shute is the Senior Physicians Editor for HealthLeaders Media.

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