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CMS sticks with E/M pay plan over some objections

Publish date: August 31, 2020

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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.


 

Specialties in line for increases under the 2021 draft rule include allergy/immunology (9%), endocrinology (17%), family practice (13%), geriatrics (4%), hematology/oncology (14%), internal medicine (4%), physician assistants (8%), psychiatry (8%), rheumatology (16%), and urology (8%).

In line for cuts would be anesthesiology (–8%), cardiac surgery (–9%), emergency medicine (–6%), gastroenterology (–5%), general surgery (–7%), infectious disease (–4%), neurosurgery (–7%), physical/occupational therapy (–9%), plastic surgery (–7%), and radiology (–11%).

An umbrella group, the Surgical Care Coalition, had a quick statement ready about the CMS proposal. Writing on behalf of the group was David B. Hoyt, MD, executive director of the American College of Surgeons.

“Today’s proposed rule ignores both patients and the surgeons who care for them. The middle of a pandemic is no time for cuts to any form of health care, but today’s announcement moves ahead as if nothing has changed,” Dr. Hoyt said in the statement. “The Surgical Care Coalition believes no physician should see payment cuts that will reduce patients’ access to care.”

Making a similar request Aug. 4 in a unified statement were the American Physical Therapy Association (APTA), the American Occupational Therapy Association (AOTA), and the American Speech-Language-Hearing Association (ASHA).

“Our organizations call on Congress and CMS to advance well-reasoned fee schedule payment policies and waive budget neutrality,” the groups said.

A version of this article originally appeared on Medscape.com.

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