AAFP Statement: AAFP Opposes Effort to Postpone Physician Payment Rule

Friday, December 11, 2009

Statement attributable to:
Lori Heim, MD
American Academy of Family Physicians

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.

Editor's Note: To schedule an interview with Lori Heim, MD, please contact Leslie Champlin, 800-274-2237, Ext. 5224, or lchampli@aafp.org.

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Founded in 1947, the American Academy of Family Physicians represents 134,600 physicians and medical students nationwide, and it is the only medical society devoted solely to primary care.

Family physicians conduct approximately one in five of the total medical office visits in the United States per year – more than any other specialty. Family physicians provide comprehensive, evidence-based, and cost-effective care dedicated to improving the health of patients, families and communities. Family medicine’s cornerstone is an ongoing and personal patient-physician relationship where the family physician serves as the hub of each patient’s integrated care team. More Americans depend on family physicians than on any other medical specialty.

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