Instead of getting a 0.5% pay increase, doctors will lose 0.18% of their Medicare payments because the Centers for Medicare & Medicaid Services could not find enough misvalued services in the 2017 Medicare physician fee schedule.
A health reform law called the Protecting Access to Medicare Act of 2014 (H.R. 4302) was designed to hold down Medicare spending by requiring CMS to identify misvalued codes based on up to 16 criteria. Once identified, the value of those codes was to be lowered by CMS by an amount equal to 1% of the overall fee schedule so that physician pay could be increased by 1%. Codes up for consideration included codes that were the fastest-growing, codes for maturing technologies, codes for services that have undergone a change in service site, and codes with a significant difference in value based on service site.
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A total of 19 potentially misvalued codes were found, including biopsy of finger or toe nail; injection of carpal tunnel; change of stomach feeding, accessed through skin; irrigation of vagina and/or application of drug to treat infection; wound closure utilizing tissue adhesive(s) only; and injection of anesthetic agent and/or steroid drug into nerve of foot. Lowering the value of those codes reduced the physician fee schedule by 0.32%, causing the 0.18% pay cut.
It is disappointing that a 0.5% fee schedule increase could not be accomplished, according to officials at the American Academy of Family Physicians.
“What I have to do in my office visit has greatly increased, whereas what it takes [specialists] to do their procedure has decreased. There needs to be an adjustment in the fee schedule,” AAFP President John Meigs, MD, said in an interview. This legislation “was supposed to spur Medicare and CMS to start making some adjustments and with these adjustments, give that tiny little pay increase to the fee schedule. That leads to the frustration of primary care physicians and family medicine physicians. We were promised a tiny pay increase and we are not going to get it.”
Dr. John Meigs
“CMS is paying lip service to increasing value of primary care, increasing the value of cognitive-based services, and they did come up with some new codes,” Dr. Meigs said. “They did some things with paying for diabetic patients that are things that they should have been paying for a long time ago. But the administrative hassle and regulatory burden of trying to do the documentation they require to actually get paid for some of these codes have a lot of physicians throwing their hands up saying, ‘it’s not worth my time to spend $5 to make a nickel.’ ”