WASHINGTON – The Centers for Medicare and Medicaid Services’ plan to increase payments to physicians who spend more time talking with their Medicare patients may be viewed in a different light due to the deferral of the 5-percent reimbursement cut.
Beginning in January, evaluation and management (E&M) services will have leveraged weight in the Medicare fee schedule as CMS looks to “encourage and support the doctor in the essence of the physician-patient relationship, which is that face-to-face interaction and management of the patient’s conditions,” said Ellen B. Griffith, a CMS public affairs specialist.
Prior to Congress’ recent provision canceling the 2007 cut, the increased payments for E&M were expected to have little or no effect. American Medical Association Board Chairman Cecil Wilson, MD said in a Nov. 1 press release that together, the two actions would result in a net change of 0 percent for family physicians and a 1-percent cut for internists.
Now, the AMA says some physicians will see increases in payment for office visits, postoperative care and certain other procedures but points out that the absence of the cut comes only as “temporary reprieve.”
Among doctors, primary care physicians are likely to see the most rewards from the E&M incentive, which will be paid through an extensive documentation system using relative value units.
David Spahlinger, MD, executive medical director of the University of Michigan’s Faculty Group Practice, said physicians will see an increase in payments in some areas, but because of factors such as the CMS’ planned practice expense adjustment (to be implemented over the next four years), physicians performing certain procedures will see decreases. “This is a budget neutral proposal,” he said.
Spahlinger said the E&M incentive does not address fundamental problems with the current payment model.
“CMS thinks we’re going to have more time to spend with our patients,” he said. “If you really want to force some change in coordination, you need to move to a model where you’re paying a capitation payment for primary services.”
Medicare patients see an average of eight physicians, he noted, and some do not see a primary care doctor.
The AMA voiced its belief that the threat to cut Medicare reimbursements could resurface in the near future. Said Wilson: “The time is long overdue to devise a sound financing system for the Medicare program so we can avoid this annual struggle to preserve seniors’ access to care.”