Academy’s Fight Over E/M Reimbursement Goes to Congress

The Academy is taking its fight against a drastic cut to 2021 Medicare reimbursements to Congress in its latest effort to reverse a planned overhaul of evaluation and management reimbursements. 

Last week the Academy confirmed that the Centers for Medicare & Medicaid Services’ proposal to overhaul E/M reimbursements would create an overall 7% cut and distort the resource-based relative value scale, unfairly hurting surgeons. Surgical specialties would take a double hit because the E/M increases will devalue surgery due to budget neutrality, in addition to withholding increases from underlying post-operative visits in the global surgical payment.

These changes won't take place until 2021, but the Academy, the American College of Surgeons and other surgical specialty groups have launched a multipronged campaign to correct the move. We’re calling on Congress to pressure CMS to apply planned payment increases for E/M services to the post-operative visits included in the global surgical codes and ensure that the E/M add-on code is not implemented in a budget-neutral manner.

Our efforts include:

• Educating our allies in Congress about how CMS’ proposal will affect surgical specialties
• Pressing for congressional action to require CMS to increase the value of post-operative visits in the global codes and eliminate the add-on code
• Urging Academy members to contact their legislators in support of our efforts

We will push Congress to include these changes in must-pass legislation to extend other Medicare and Medicaid programs in May 2020. Should these efforts in Congress fail, there’s potential for the Academy to join in legal action, but such action can’t take place until 2021.

It’s been a long-running battle over E/M changes. In a previous CMS E/M proposal, the Academy, the American Medical Association and others successfully derailed a proposal to collapse the number of visit levels from five to three, and won a chance to develop a more favorable alternative.

The Academy participated in the development of a medicine-wide plan at the Relative Value Scale Update Committee. But the two changes CMS made to medicine’s plan worsened the situation for surgeons.