I am a very happy blogger today. CMS has published the proposed new rule on reimbursement for billing codes. You can find the details – Medicare Program; Five-Year Review of Work Relative Value Units Under the Physician Fee Schedule and Proposed Changes to the Practice Expense Methodology

What the heck? This over 600 page document explains how the RUC (RVS Updating Committee) makes recommendations to CMS and why CMS is accepting the recommendations.

The ACP released this statement – ACP Commends CMS Proposals to Increase Values Assigned to Evaluation and Management Codes

ACP has determined that inadequate and dysfunctional payment policies, including the undervaluation of E/M services, combined with high levels of medical student debt, are key drivers behind the impending collapse of primary care,” Dr. Lynne M. Kirk, MD, FACP, President of ACP emphasized. “Medicare, as the single largest purchaser of health care in the United States, can lead by replacing policies that are antithetical to primary care with ones designed to encourage and support its importance and growth.”

The Medicare law requires that CMS offset the increased Medicare spending resulting from relative value increases, which CMS proposes to do by applying a special adjustment factor that will fully offset the costs associated with the work RVU increases. After the budget neutrality adjustment is applied, physicians who see the most Medicare patients in face-to-face E/M visits will experience significant increases in Medicare payments, while some physicians who provide fewer E/M services will experience payment reductions. Such redistribution will begin to correct long-standing reimbursement disparities that are contributing to the looming crisis in access to primary care and help ensure an adequate supply of internists and other physicians to care for an increasingly aging population.

“ACP encourages CMS to hold the line on its proposal at the end of the 60-day public comment period and include the proposed E/M work RVUs in the final fee schedule to be published by Nov. 1,” Dr. Kirk concluded.

AAIM (the Alliance for Academic Internal Medicine) has this statement – CMS Proposes Increases to E/M Work RVUs

The proposed changes in physician fee schedule, initially proposed by a consortium of organizations to the American Medical Association’s Relative Value Update Committee (RUC), would increase the percentage of work relative value units (RVUs) for 400 services associated with the time and effort physicians spend evaluating a patient’s condition, preparing a diagnosis, prescribing treatment, and providing ongoing care. For example, CMS proposes increasing by 37 percent the work RVUs associated with an intermediate office visit, the most commonly billed physician service. Please refer to the chart below for further proposed changes to work RVUs relating to evaluation and management services.

The proposed adjustments would increase Medicare costs by an estimated $4 billion. Due to this increase, federal measures created to ensure budget neutrality will come into effect. According to a recent press release, CMS proposes maintaining budget neutrality by reducing work RVUs for all physician services by an estimated 10 percent after the proposed changes are effective.

I have spent some time studying the CMS proposal, and have extracted a table below to increase my own understanding. It may help you also. It is an html file, so you will need to click to open it up.

Spreadsheet of CMS rule impact

While this proposal is specific for Medicare, most private insurers adjust their payment schedule to Medicare payments. This rule, if accepted, may well have a huge positive effect on the future of generalist care – both outpatient and inpatient. This is very good news for family medicine, general internal medicine, and the cognitive internal medicine subspecialties.