AAFP's Influence Clearly Visible in CMS' 2019 MPFS Final Rule

E/M Documentation Guidelines Delay an Advocacy Win for Academy

November 06, 2018 09:30 am News Staff – More time and less administrative burden. That's the balance struck in the 2019 Medicare physician fee schedule (MPFS) final rule CMS issued Nov. 2, which acknowledges key recommendations advocated by the AAFP.

The rule "is a step forward in easing administrative burden and improving patient access to care," said AAFP President John Cullen, M.D., of Valdez, Alaska, in a Nov. 6 statement.

Crucially, CMS is enacting several positive changes to evaluation and management (E/M) documentation guidelines in 2019, while postponing payment-related E/M changes until Jan. 1, 2021. In step with advice from the Academy and peer organizations, the agency is allowing time for the AAFP and its fellow stakeholders to collaborate with CMS to achieve better E/M policies, codes and descriptors.

Reflecting the Academy's advocacy priorities, the 2019 final rule eliminates an outdated requirement that physicians redocument medical and exam history. Physicians now only need to document that they reviewed and verified information already entered into the medical record by practice staff or the patient. When a patient's medical record already includes relevant data, physicians now can focus on documenting solely what has changed since the last visit.

Also going away is the mandate that physicians document medical necessity when conducting a non-office visit.

Cullen, in his statement, applauded CMS "for implementing, as part of a separate final rule, the AAFP's recommendation to establish site-neutral payments for medical services, regardless of whether they are provided in a community-based physician’s office or a clinic designated as a hospital outpatient department."

He added, "This discrepancy has encouraged hospital purchases of physician practices, reduced Medicare patients' choices for medical care and increased beneficiaries' out-of-pocket expense. Ending this disparity will serve patients and the community on multiple levels."

Among other AAFP-supported CMS proposals set to go into effect next year is separate payment for two newly defined physician services: virtual check-in and remote evaluation of recorded video or images submitted by an established patient.

"Patient access to care will improve as a result," Cullen said. "This will enhance access to timely patient care, particularly for those who struggle with transportation barriers."

The Academy's advocacy is also evident in what the 2019 rule lacks.

A proposed $5 primary care add-on code, to which the AAFP objected, was not finalized. Neither was a Multiple Procedure Payment Reduction policy that would have reduced payment for certain same-visit E/M services at practices listing family medicine, internal medicine, pediatrics or geriatrics as their primary focus.

Last but not least, the final 2019 MPFS conversion factor, $36.0391, ticks up marginally from the 2018 conversion factor of $35.9996.

CMS is offering a fact sheet on the final rule's provisions, as well as an E/M payment chart. The agency is accepting comments on certain sections of the rule until Dec. 31. The Academy is preparing a response to CMS and also will provide a more detailed breakdown of the rule for members.