Healthcare industry groups applaud CMS for delaying implementation of E/M payment changes

The American Hospital Association (AHA) and American Medical Group Association (AMGA) recently commended CMS for delaying implementation of E/M payment policies proposed for implementation on January 1. 

In the 2019 Medicare Physician Fee Schedule (MPFS) final rule, released on November 1, CMS announced that it will collapse payment rates for E/M office visits levels 2 through 4, rather than levels 2 through 5 as stated in the proposed rule, beginning in 2021. The agency will keep a separate payment rate for level 5 visits to account for time and care associated with the treatment of complex patients, according to the final rule.

The AHA released a statement applauding CMS for its decision to retain three levels of E/M codes and delay implementation of payment changes until 2021. The AHA had previously urged CMS not to collapse levels 2 through 5, arguing that this would financially penalize providers who see the sickest patients and potentially reduce patient access to care.

According to the statement, CMS’s decision to keep a separate payment rate for level 5 visits and delay implementation of E/M payment changes will “allow [the AHA] to work with the agency to ensure that physicians who treat a disproportionate number of higher-acuity patients are not financially penalized.”

The AMGA also expressed support for CMS’ decision to delay payment changes until 2021 in a statement. Prior to the release of the final rule, members of the AMGA were concerned that CMS was moving too aggressively in its plan to consolidate E/M payment rates. According to the statement, CMS’ plan to move forward with documentation changes in 2019 while delaying the payment and coding changes addresses the AMGA’s concern.

The AHA and AGMA are more supportive of the E/M changes and plan on working with CMS to refine the payment policy. However, both groups have expressed concern over MPFS policies effective in 2019, including reduced payments for certain new drugs and high Merit-based Incentive Payment System exclusion thresholds.