AAFP Pushes CMS to Pay PCPs for Hospital Consulting Expertise

September 22, 2015 01:51 pm News Staff

In an effort to ensure that family physicians are paid appropriately for the services they provide to patients, the AAFP has urged CMS and private payers to "review and revise" their coverage policies so that they recognize primary care physicians (PCPs) as specialists when acting in a consulting role in the care of a hospitalized patient.

[Doctor handshake at male patient's bedside]

In a Sept. 16 letter(2 page PDF) to CMS Acting Administrator Andy Slavitt, AAFP Board Chair Reid Blackwelder, M.D., of Kingsport, Tenn., stated, "There are benefits to having a patient's primary care physician involved in the patient's hospital care even in those cases in which a hospitalist of the same specialty is involved."

Blackwelder pointed out that since Jan. 1, 2010, CMS has not recognized consultation codes for Medicare Part B payment. Rather, Medicare expects physicians to report patient care with evaluation and management (E/M) codes that represent where the visit occurred and that identify the complexity of the visit.

That means that if a family physician is called on by a hospitalist to see that FP's patient in the hospital, the family physician has to bill an appropriate hospital visit E/M code for providing that service.

The AAFP's concern is that when hospitalists ask the patient's primary care physician to weigh in on the patient's care, "The primary care physician's service is too often viewed as medically unnecessary concurrent care, especially when the hospitalist and the primary care physician are of the same specialty," said Blackwelder.

CMS clearly does not "recognize the value" that primary care physicians bring to these situations, Blackwelder admonished.

The AAFP knows there is value in paying primary care physicians to see their patients in a hospital setting, said Blackwelder. Furthermore, evidence suggests there are enormous benefits in terms of improved patient outcomes and cost savings, he added.

However, circumstances in the health care marketplace have, in some situations, changed the dynamics of the relationship between PCPs and their hospitalized patients.

"Many primary care physicians have chosen to no longer practice hospital medicine due either to lifestyle choices or to the hospitalist movement," said Blackwelder. "In other cases, some hospitals and insurance companies have chosen to exclude primary care physicians from admitting patients."

For patients, that means that when they most expect and need to see their trusted physician at the bedside, a sometimes frightening hospital stay is, instead, overseen by a stranger.

Most unsettling is the fact that the hospitalist is unfamiliar with the patient's medical history.

"Unfortunately, lack of communication between hospitals, hospitalists and the patient's primary care physician leads to unnecessary testing, medications which may have been tried on the patient previously without success and, therefore, generally poorer outcomes as compared to when the patient's primary care physician is involved in a patient's hospital care," said Blackwelder.

"Unnecessary testing, numerous specialty consultations and prolonged hospitalizations, in turn, generally lead to increased costs of hospitalizations," he added.

The bottom line, Blackwelder concluded, is that CMS needs to revise its coverage and payment policies to fix this untenable situation as soon as possible.

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