Bold Proposed Rule for the 2019 Medicare Physician Fee Schedule: Can Physicians Afford to Abandon Documentation Burdens?
Authors: Scott Manaker, M. Douglas Leahy
Journal: Annals of Internal Medicine (2018)

Ideas and Opinions16 October 2018Bold Proposed Rule for the 2019 Medicare Physician Fee Schedule: Can Physicians Afford to Abandon Documentation Burdens?Scott Manaker, MD, PhD and M. Douglas Leahy, MDScott Manaker, MD, PhDPerelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania (S.M.) and M. Douglas Leahy, MDSummit Medical Group, Knoxville, Tennessee (M.D.L.)Author, Article, and Disclosure Informationhttps://doi.org/10.7326/M18-2115 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail The proposed rule for the 2019 Medicare Physician Fee Schedule contains a bold proposal to eliminate mandated documentation guidelines for outpatient evaluation and management services in exchange for a flat, fixed payment rate and relief from audit burdens (1, 2). The physician work relative value units would remain the same for Current Procedural Terminology (CPT) codes 99201 to 99205 and 99211 to 99215 (1, 2). To justify reporting a particular CPT code in their office note, physicians would have several options. They could use the current guidelines, which range from the minimal documentation required for CPT code 99212 to the ...References1. Medicare Program; Revisions to Payment Policies Under the Physician Fee Schedule and Other Revisions to Part B for CY 2019, 83 FR 35704 (proposed 27 July 2018). Accessed at www.federalregister.gov/documents/2018/07/27/2018-14985/medicare-program-revisions-to-payment-policies-under-the-physician-fee-schedule-and-other-revisions on 30 July 2018. Google Scholar2. American Medical Association. CPT 2018 Professional Edition. Chicago: American Med Assoc Pr; 2017. Google Scholar3. Kassirer JP, Angell M. Evaluation and management guidelines—fatally flawed [Editorial]. N Engl J Med. 1998;339:1697-8. [PMID: 9834308] CrossrefMedlineGoogle Scholar4. Kuhn T, Basch P, Barr M, Yackel T; Medical Informatics Committee of the American College of Physicians. Clinical documentation in the 21st century: executive summary of a policy position paper from the American College of Physicians. Ann Intern Med. 2015;162:301-3. [PMID: 25581028]. doi:10.7326/M14-2128 LinkGoogle Scholar5. Erickson SM, Rockwern B, Koltov M, McLean RM; Medical Practice and Quality Committee of the American College of Physicians. Putting patients first by reducing administrative tasks in health care: a position paper of the American College of Physicians. Ann Intern Med. 2017;166:659-61. [PMID: 28346948]. doi:10.7326/M16-2697 LinkGoogle Scholar6. Downing NL, Bates DW, Longhurst CA. Physician burnout in the electronic health record era: are we ignoring the real cause? Ann Intern Med. 2018;169:50-1. [PMID: 29801050]. doi:10.7326/M18-0139 LinkGoogle Scholar7. Goodson JD. Unintended consequences of resource-based relative value scale reimbursement. JAMA. 2007;298:2308-10. [PMID: 18029836] CrossrefMedlineGoogle Scholar8. Pham HH, Pilotte J, Rajkumar R, Richter E, Cavanaugh S, Conway PH. Medicare's vision for delivery-system reform—the role of ACOs. N Engl J Med. 2015;373:987-90. [PMID: 26352812] doi:10.1056/NEJMp1507319 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania (S.M.)Summit Medical Group, Knoxville, Tennessee (M.D.L.)Disclaimer: The opinions in this article are those of the authors and do not necessarily represent the views of the societies and organizations they serve.Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M18-2115.Corresponding Author: Scott Manaker, MD, PhD, Department of Medicine, Perelman Center for Advanced Medicine, University of Pennsylvania, 3400 Civic Center Boulevard, South Pavilion, 6th Floor, Room 624, Philadelphia, PA 19104; e-mail, scott.[email protected]upenn.edu.Current Author Addresses: Dr. Manaker: Department of Medicine, Perelman Center for Advanced Medicine, University of Pennsylvania, 3400 Civic Center Boulevard, South Pavilion, 6th Floor, Room 624, Philadelphia, PA 19104.Dr. Leahy: Summit Medical Group, 1225 East Weisgarber Road, Suite N-200, Knoxville, TN 37909.Author Contributions: Conception and design: S. Manaker, M.D. Leahy.Analysis and interpretation of the data: S. Manaker.Drafting of the article: S. Manaker, M.D. Leahy.Critical revision of the article for important intellectual content: S. Manaker.Final approval of the article: S. Manaker, M.D. Leahy.Statistical expertise: M.D. Leahy.Administrative, technical, or logistics support: S. Manaker, M.D. Leahy.Collection and assembly of data: S. Manaker.This article was published at Annals.org on 7 August 2018. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoWhen Centers for Medicare & Medicaid Services Treats Throat Cancer Like Pharyngitis Atul Grover and Gayle Lee Metrics Cited byNew Billing Rules for Outpatient Office Visit CodesImplementation of quality measures and patient-reported outcomes in an epilepsy clinicMedicare's Approach to Paying for Services That Promote Coordinated Care 16 October 2018Volume 169, Issue 8Page: 570-572KeywordsCurrent procedural terminologyDecision makingDisclosureElectronic medical recordsEmergency departmentForecastingInpatientsMedicareOutpatientsPatients ePublished: 7 August 2018 Issue Published: 16 October 2018 Copyright & PermissionsCopyright © 2018 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...