Physician groups support CMS plan to streamline E&M documentation

A proposed rule by the Centers for Medicare and Medicaid Services to streamline Evaluation and Management documentation requirements for providers has strong support among physician groups.

The proposal, included in the Calendar Year 2019 Medicare Physician Fee Schedule, has the backing of the American Medical Association and about 150 medical groups, which sent a letter of support to CMS Administrator Seema Verma.

Current Medicare documentation requirements for payment have resulted in a time-consuming process for clinicians that has only served to distract them from caring for patients, contend the groups.

“Excessive E&M documentation requirements do not just take time away from patient care; they also make it more difficult to locate medical information in patients’ records that is necessary to provide high quality care,” states the letter. “Physicians and other healthcare professionals are extremely frustrated by ‘note bloat,’ with pages and pages of redundant information that makes it difficult to quickly find important information about the patient’s present illness or most recent test results. Several of the documentation policy changes included in the proposed rule would go a long way toward alleviating this problem and the undersigned organizations urge immediate adoption.”

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Also See: CMS proposed rule reduces Evaluation and Management coding burden

In particular, the AMA and other groups support changing the required documentation of the patient’s history to focus only on the interval history since the previous visit, as well as eliminating the requirement for physicians to re-document information that has already been documented in the patient’s record by practice staff or by the patient.

While the groups would like to see a significantly less documentation burden for clinicians treating Medicare beneficiaries, they expressed concerns in their letter to Verma about a provision in the CMS proposal to collapse payment rates for eight office visit services for new and established patients down to two each.

“The undersigned organizations believe there are a number of unanswered questions and potential unintended consequences that would result from the coding policies in the proposed rule,” states the letter. “We oppose the implementation of this proposal because it could hurt physicians and other healthcare professionals in specialties that treat the sickest patients, as well as those who provide comprehensive primary care, ultimately jeopardizing patients’ access to care.”

In addition, the groups urged that the “new multiple service payment reduction policy in the proposed rule not be adopted as the issue of multiple services on the same day of service was factored into prior valuations of the affected codes” and that the proposal “also has significant impact on certain services, such as chemotherapy administration, that may be an unintended consequence of altering the current practice expense methodology to accommodate the proposal.”

Likewise, a separate coalition of 126 patient and provider groups sent a letter to CMS requesting that the agency not move forward with a proposal that would significantly reduce Medicare reimbursements for E&M services provided by specialists.

“We applaud CMS for recognizing the problems with the current evaluation and management documentation guidelines and codes and including a significant proposal addressing them in the CY 2019 physician fee schedule proposed rule,” states the letter. “However, we urge CMS to reconsider this proposal to cut and consolidate evaluation and management services, which would severely reduce Medicare patients’ access to care by cutting payments for complex office visits, adversely affecting the care and treatment of patients with complex conditions, and potentially exacerbate physician workforce shortages.”

While the groups—which include American Heart Association and American Stroke Association—support the agency’s goal of increasing the amount of time physicians have to spend with patients instead of on their computers, they contend that the “collapsing of evaluation and management codes would have an immediate and lasting effect of restricting patient access to care.”

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