The American Academy of Family Physicians is calling on the Centers for Medicare and Medicaid Services to develop a new set of evaluation and management codes specifically for primary care physicians.

The codes would result in increased payment reflecting a higher intensity and complexity of care that PCPs give, as compared with other specialists, according to the organization in a recent letter to CMS. “We believe that the complexity of the ambulatory and management services that primary care physicians must ‘fit’ into the time available for the average patient visit is sufficiently distinct to merit dedicated codes and higher relative values than currently assigned to existing office or other outpatient codes,” AAFP contends in the letter, which includes a technical paper making its case in detail.

During the past two decades, the number and variety of preventive services delivered during a PCP visit has increased, as has the demographic diversity of patients, and medications and other treatments have evolved to be more central to ambulatory practice, according to the letter. “While all medical care is becoming more complex, the trend is more pronounced in primary care. The AAFP has grown concerned that the current Relative Based Relative Value Scale system does not accurately capture and reflect the complexity of modern primary care practices. The current coding and evaluation system does not account for the variation in intensity when office or other outpatient E/M services are rendered by different specialists. The same number of relative value units is assigned to a single E/M visit, regardless of the specialty of the physician providing the service. The AAFP considers this approach to be flawed and worthy of reform.”

The bottom line, according to the association, is that PCPs do more in a typical office visit than other specialists do. “We believe an office or other outpatient primary care visit involves more than just addressing the problem,” the association argues in the letter to CMS. “For example, imagine an adult male presenting with a medical condition that could be treated by either a primary care physician or a specialist. Whereas the encounter with the specialist is likely to address only the presenting issue, the encounter with the primary care physician likely will entail important additional work--such as review of age appropriate immunizations and preventive services, assessing other co-morbid conditions (if the patient has multiple conditions), dietary and exercise assessments, ect.”

While current E/M policies are based on problem identification and management, primary care today is more proactive and strategic, AAFP says. “Codes for these ambulatory E/M services provided in primary care should accurately capture and value that physician work.”

The letter to CMS is available here.

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