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June 20, 2018

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MedPAC May Recommend a $2.4 Billion Increase in Medicare E/M Payments

In its June 15 report to Congress, the Medicare Payment Advisory Committee (MedPAC) announced that it may recommend a one-time 10 percent increase in Medicare payments for physicians who rely on ambulatory evaluation and management (E/M) CPT® codes to help rebalance the Medicare Physician Fee Schedule. According to the report, “the relative prices for ambulatory E&M services are too low because the prices for other services have become artificially high. We call this process 'passive devaluation.'" MedPAC proposes payment increases for many cognitive specialties, and while ID physicians are not specifically mentioned in the report, MedPAC estimates that internal medicine physicians would receive a 1.7 percent increase in payment. IDSA will advocate for ID physicians to receive at least a commensurate increase and will continue advocating for broader reforms to address ID physician compensation disparities.

MedPAC’s potential recommendation may be an important step forward in the effort to re-value E/M codes. This a welcome outcome after an April meeting with MedPAC Executive Director James Mathews, PhD. Those attending this meeting included IDSA staff and members as well as other organizations belonging to the Cognitive Specialty Coalition (CSC). IDSA discussed the impact of undervalued E/M codes on ID workforce capacity, and pressed MedPAC to communicate the need for action from the Centers for Medicare & Medicaid Services (CMS) to develop a comprehensive, long-term plan for revaluing E/M codes. 

IDSA is pleased that MedPAC’s report urges CMS to accelerate its efforts to improve the accuracy of the Medicare Physician Fee Schedule to ensure access to cognitive care and send a positive signal to medical students and residents considering cognitive specialties. However, we believe that MedPAC’s recommendation should encompass both inpatient and ambulatory E/M codes to address the full spectrum of important services provided by ID physicians.  Further, while a one-time payment increase signifies progress, a more complete review and revaluation of E/M codes is still needed to ensure that the codes reflect the complexity of care provided to infectious diseases patients.

IDSA will advocate that MedPAC expand its recommendation to include inpatient E/M codes and for Congress to support the prospective MedPAC recommendations. We will also continue to work with the CSC and the Cognitive Care Alliance to push Congress and CMS to ensure that the agency moves swiftly to undertake the research necessary to revalue E/M codes.

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