New AAFP Task Force Will Evaluate, Appraise Worth of Primary Care Services

The AAFP has formed a new task force to review the methods used to evaluate health care services provided via Medicare and to make recommendations about how to properly value and pay for services provided by primary care physicians. The committee, known as the Primary Care Valuation Task Force, will concentrate on finding ways to more appropriately appraise the worth of evaluation and management, or E/M, services, the most common services provided by primary care physicians.

Currently, the AMA/Specialty Society Relative Value Scale Update Committee, or RUC, which includes only representatives from medical specialty societies, acts as an expert panel in making recommendations on the relative values of various CPT codes, including codes commonly used by family physicians, and CMS typically adopts the committee's recommendations for the Medicare program. However, many family physicians are concerned that the RUC's recommendations undervalue primary care services. In response, the AAFP has formed the task force to provide a separate and independent evaluation of the process.

"Increasingly, research suggests that the complexity of primary care physicians' evaluation and management services (is) different and more intense than the E/M services provided by other specialties," said AAFP Board Chair Lori Heim, M.D., who also is chairing the new task force, in a prepared statement. "As a matter of fact, CMS recognized in (its) 2012 proposed Medicare Physician Fee Schedule the need to review primary care codes and asked the RUC to prioritize the review of these E/M codes."

"The long-term and ongoing actions of the RUC are overly influenced by subspecialist procedures and give short shrift to primary care and its complexities," said task force member Brian Klepper, Ph.D., of WeCare TLC Onsite Clinics. "The valuation process would benefit substantially if CMS had an alternative, more modern and transparent means of identifying misvalued services and calculating RVUs."

The creation of the task force comes after the AAFP sent a strongly worded letter to the chair of the RUC on June 10 asking for changes in its structure, process and procedures to include the following:

The AAFP has asked the RUC to make a decision about these changes by March 1.

In the meantime, the Primary Care Valuation Task Force, which consists of representatives from medical specialty societies and health care experts from academic institutions and the private sector, will also focus on alternative payment methods that could work within the current fee-for-service model.

"The fee-for-service payment system will continue to be the foundation of the payment system while alternative methods are developed," said Robert Berenson, M.D., a fellow at the Urban Institute and a member of the task force. "As such, fee-for-service payment needs direct and urgent attention so primary care services are properly valued and the system ends the current payment inequities when new models of payment are fully applied."

The task force comprises the following members:

At the end of the six- to nine-month project, task force members will present their findings to the AAFP Board of Directors. In turn, the AAFP Board is expected to present the recommendations directly to CMS for its consideration in assessing the appropriate work relative value units, which measure the worth of a service, and determining Medicare fee-for-service payments to primary care physicians.