APTA Says Proposed Evaluation and Management Payment Plan a Danger to Sicker Patients

The American Physical Therapy Association is one of 150+ organizations that has formally asked the US Centers for Medicare and Medicaid Services (CMS) to reconsider its proposed “Patients Over Paperwork” efforts.

While there is almost universal praise for the idea of putting patients’ well-being above bureaucracy, a lot of folks are aghast at the short-sighted idea that is currently on the table. “The concerns center around a provision related to evaluation and management (E/M) visits included in the 2019 physician fee schedule rule…The change, ostensibly intended to reduce paperwork, would collapse E/M payment rates currently based on a 5-level complexity system for new and established patients into what would amount to a 2-level system—combining levels 1-3 and levels 2-5. CMS acknowledges that the change would result in higher payments for E/M visits at the 1-3 levels while levels 4 and 5 will see reductions based on the 2019 proposed relative value units…In a letter sent to CMS last month, APTA and other cosigners praise CMS for its initiative to reduce provider paperwork, but question the wisdom of the E/M plan, arguing that the change would unfairly impact providers who see sicker patients, “‘ultimately jeopardizing patients’ access to care.'”

Instead, the APTA group has asked CMS to work with the cross-disciplinary work group sponsored by the American Medical Association. They are on a mission to analyze E/M coding and develop a more palatable option than the one currently under consideration.

The APTA promises to keep its eyes on this process and participate in the process going forward.

If you would like more information about the APTA or its advocacy work, please click on the link above.

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