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AAFP Opposes Effort to Postpone Physician Payment Rule

By Lori Heim, MD

The American Academy of Family Physicians strongly opposes the Senate amendment introduced by Sen. Arlen Specter, D-Pa. This amendment would postpone implementation of the
CMS 2010 fee schedule that would begin to pay appropriately for the medical services provided to patients, end wasteful spending of our limited resources, and strengthen primary care which has been shown to be the foundation of a high quality health care system.

The CMS rule eliminates consultation codes and redistributes savings to all evaluation and management office visits. As a result, payment for office visits would increase by 6 percent. The elimination of consultation codes was based on a sound evaluation of the work currently involved and the difference between the various available codes.

This amendment would prolong the kind of wasteful spending cited in the 2006 Office of the Inspector General report, “Consultations in Medicare: Coding and Reimbursement.” The report found that, of services billed as consultations and allowed by Medicare,

— 19 percent or $191 million in payments did not meet Medicares definition of a consultation;
— 47 percent or $613 million in payments were billed as the wrong type or level of consultation; and
— 9 percent or $260 million in payments were not substantiated by documentation.

Moreover, this amendment would extend Medicare payment for nonexistent services. Consultation codes pay for office visits to specialists that are the same as office visits conducted by primary care physicians.

Higher payment under consultation codes was designed to compensate for the additional report the consulting physician was required to send to the referring physician. Because the CMS 2010 fee schedule and rules no longer requires these reports, the additional payment is no longer justified.

Decades of physician payment policies have worn down the primary care foundation of our nation’s health system. Today, Americans struggle with a serious and growing primary care physician shortage in a fragmented, confusing and costly system. Postponing implementation of the CMS fee schedule and rule would permit that erosion and inefficiency to continue by maintaining current payment policies.

Lori Heim, MD, is President, American Academy of Family Physicians

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