AAFP Statement: AAFP Proposes New Primary Care-Specific Evaluation and Management Codes to Increase Payment for Primary Care Services

Friday, April 05, 2013

Statement Attributable to:
Glen Stream, MD, MBI
Board Chair
American Academy of Family Physicians

“On March 27, the American Academy of Family Physicians issued a letter(43 page PDF) to the Centers for Medicare and Medicaid Services calling for the development of a new set of evaluation and management codes specifically for primary care physicians that would result in increased payment for the intensity and complexity of care and work provided by primary care physicians. The AAFP has asked CMS to consider creating the new codes for inclusion in the 2014 Medicare Physician Fee Schedule.

“A report that features the work of David A. Katerndahl, MD, MA, accompanied the letter and makes the case that the intensity and complexity of an E/M encounter with a primary care physician is demonstrably different, both qualitatively and quantitatively, than encounters with other specialists. The existing E/M codes do not adequately reflect the scope of our responsibilities and the complexity of the care that we provide in the office and other outpatient settings. Primary care E/M services should be valued higher than E/M services provided by other specialists.

“This most recent request to CMS is a continuation of strong, ongoing efforts by the AAFP on behalf of its members to reform fee-for service payment for primary care services. In 2012, the AAFP Board of Directors made the decision to remain an active participant in the AMA/Specialty Society Relative Value Scale Update Committee (RUC), despite ongoing concerns that the current process has historically undervalued primary care services in its recommendations to CMS. The AAFP took a stance that it would participate in the RUC process while also advocating directly with CMS.

“Around the same time, the AAFP’s Primary Care Valuation Task Force made recommendations that included creating primary-care specific E/M codes and valuing primary care E/M services differently than those provided by subspecialists in the current fee-for-service model.

“While the AAFP is grateful CMS has increased the value of the current office or other outpatient E/M codes in the past, such payment increases apply to any physician performing such an E/M service, regardless of whether the physician is performing a primary care service. As a result, CMS has explicitly extended payment increases for non-primary care services. The AAFP will continue advocating on behalf of its members for payment commensurate with the intensity and complexity performed at the primary care level.”

Editor's Note: To arrange an interview with Dr. Stream, contact Janelle Davis, 800-274-2237, Ext. 5222, or jdavis@aafp.org.

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Founded in 1947, the American Academy of Family Physicians represents 136,700 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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