American College of Physicians: Internal Medicine — Doctors for Adults ®

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Proposed changes would boost Medicare payments

From the July-August ACP Observer, copyright © 2006 by the American College of Physicians.

The Centers for Medicare and Medicaid Services (CMS) last month proposed significant increases to Medicare payments for numerous evaluation and management (E/M) services, including office visits, hospital visits and consultations.

The proposed changes would substantially boost physician payments. The changes would, for example, increase the national average payment for an intermediate office visit—CPT code 99213, the code internists bill most frequently—by 12.8%. The national average payment for a moderately complex follow-up hospital visit, CPT code 99232, would rise by 13.7%.

If changes are implemented on Jan. 1, 2007 as the CMS proposes, ACP estimates that overall Medicare payments to internists would increase on average between $4,000 and $9,000 per year. The College expects many private payer payments to also increase as many based payments on Medicare methodology.

The proposed changes indicate that the CMS recognizes that the work physicians put into furnishing E/M services has increased dramatically in the 10 years since the agency last reviewed E/M payments. For more than a year, ACP has led a coalition of organizations representing internal medicine subspecialists and other E/M-oriented physicians to document that E/M services are undervalued and to develop evidence to persuade an advisory committee to recommend that the CMS substantially increase E/M payments.

As significant as the changes would be for internists, ACP views the proposed increases "as just one important step in the College's multi-faceted efforts to propose fundamental payment reforms," said Robert B. Doherty, ACP's Senior Vice President for Governmental Affairs and Public Policy. "Those reforms are needed to address payment inequities that undervalue internists' services."

The CMS is accepting public comments on the E/M and other proposed changes through Aug. 21. The agency will review those comments and announce final 2007 Medicare payments in November 2006.

Additional information—-including details on proposed E/M changes, as well as a tool College members can use to estimate the specific impact on their practice and instructions for submitting comments to the CMS—is online.

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