• AAFP Advocacy Focus: Medicare Physician Fee Schedule (MPFS)

    Overview

    The Medicare Access and CHIP Reauthorization Act, signed in April 2015, set in motion a number of changes, including This law

    • a repeal of the Sustainable Growth Rate methodology for determining updates to the Medicare physician fee schedule;
    • establishment of annual positive or flat fee updates for 10 years, and a two-track fee update afterward;
    • establishment of a merit-based incentive payment system that consolidates existing Medicare fee-for-service physician incentive programs;
    • establishment of a pathway for physicians to participate in alternative payment models, including the patient-centered medical home; and
    • other changes to existing Medicare physician payment statutes.

    The 2020 Medicare Physician Fee Schedule, issued November 1, 2019, which also affects the Quality Payment Program, sets the 2020 MPFS conversion factor at $36.0896, leaving it unchanged from 2019.. However, total allowed charges for family medicine are scheduled to increase 12% in 2021.

    The AAFP commented on the 2020 proposal in a September 18, 2019, letter.

    Why We Fight

    More than 90% of family physicians accept Medicare. It is the bedrock of primary care. Yet the annually updated Medicare physician fee schedule does not necessarily advance a primary care–centered health system that improves health and reduces system costs.

    After years of lobbying by the AAFP, CMS in 2019 slated a 12% increase in values for evaluation and management coding, to begin in 2021 — a long-sought raise for family physicians.

    In 2020, the Academy is pushing CMS to follow through with that revision and to resist pressure from other medical specialties to reverse course.

     


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