TAFP member’s research basis for AAFP recommendation to CMS

Tags: medicare, medicaid, centers for medicare and medicaid services, katerndahl, payment, evaluation, coding

AAFP recently submitted a letter to the Centers for Medicare and Medicaid Services urging them to create a new set of evaluation and management codes for primary care physicians. The recommendation, sent to CMS Acting Principal Deputy Administrator Jonathan Blum, was accompanied by supporting documents based on the research of TAFP member David Katerndahl, M.D., M.A.

The Academy suggested that CMS create the codes and include them in the 2014 Medicare physician fee schedule. AAFP Board Chair Glen Stream, M.D., said in the letter that a new payment model is necessary for the country to reach better health care for people and populations, as well as lower health care costs. “That system should recognize the complexity of ambulatory care provided by primary care physicians and reward the quality of services provided in their practices,” said Stream.

New E/M codes that differentiate primary care physicians from specialists or subspecialists would show the true value of both types of care, rather than devalue them as the current coding system does. Katerndahl’s research shows that the complexity of a primary care physician’s patient visit including E/M is much different than those with other specialists.

In the letter, Stream acknowledged that CMS might encounter some “operational issues” in creating new codes, namely defining primary care physicians. AAFP says that primary care physicians perform three functions – “first contact with the patient, continuity of care, and comprehensiveness of care.” The Academy also believes that physicians trained in primary care should be eligible for the new E/M codes.

In addition to the letter to CMS, AAFP also created a Primary Care Valuation Task Force in 2011, which officially released recommendations in 2012 that included primary care-specific codes such as these.

> Read the AAFP letter to CMS and see Katerndahl’s research
> Read the AAFP News Now story

– samantha

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