Proposed CMS codes and fees align with realities for physicians

The Centers for Medicare & Medicaid Services (CMS) are bowing to the reality of all that primary care practices are asked to do these days. CMS is proposing a Medicare 2017 Physician Fee Schedule that recognizes the added complexity of these demands and the expanding role of the family physician.

CMS is expected to issue final rules before the end of 2016 on adding codes and increasing payment in 2017 for managing multiple chronic conditions, providing mental and behavioral healthcare, and treating patients with cognitive or mobility-related impairments.

An increasing number of Americans live with multiple chronic conditions that require complex care and care management that goes well beyond simple office visits. It may involve consultations with and referrals to specialists and therapists, checks for medication interactions, and the prioritizing and sequencing of treatments. All of this challenges a physician’s time and resources.

While Medicare began covering care coordination for multichronic patients in 2015, physician organizations have argued that compensation for this work is inadequate. Other changes include adjusting chronic care codes to simplify treatment delivery and billing.

Why special situations deserve higher fees

  • Patients with mental and behavioral health issues often turn up in their primary care providers’ offices with vague complaints about pain, inability to sleep and family problems. These symptoms often have a mental health origin. Family physicians prescribe an estimated 85 percent of antidepressants in the United States and want reimbursement for this care.
  • CMS is proposing a new code supporting physicians who treat conditions such as dementia or other cognitive impairments. This reflects the extra resources it takes to assess and plan care for these patients.
  • For patients with mobility-related concerns, physicians will be better compensated with the recognition that patients with these issues often require more physical assistance, and more physician and staff time during a visit.

Many of these changes are a response to the realities of caring for an aging and often sicker population. The new codes and improved reimbursement respect that primary care physicians are usually the first – and sometimes only – point of contact patients have with the medical system.

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