CMS Proposes Change to Evaluation-and-Management Payment Model

Many physicians who treat Medicare patients may see an end to unreimbursed evaluation-and-management (E&M)

Many physicians who treat Medicare patients may see an end to unreimbursed evaluation-and-management (E&M). Starting in 2015, the Centers for Medicaid & Medicare Services (CMS) is proposing reimbursement for patient care-management activities that don't involve face-to-face contant. Modern Healthcare reports:

Medicare beneficiaries with chronic conditions generate a set fee for each visit to the Center for Primary Care in Augusta, Ga. Yet that visit will generate numerous tasks—including making referrals to calling in prescriptions to answering questions over the telephone from the patient's spouse. None is reimbursed by the CMS.

“For every E&M visit we get reimbursed for, there are seven other items of work that we don't get reimbursed for,” said Dr Paul Fischer, founder of the Center for Primary Care. “The vast majority of our work gets done outside of the 15 minutes you spend in the exam room.”

For hundreds of thousands of primary-care physicians across the country like the 27 who practice at the seven sites run by the Center for Primary Care, the era of unreimbursed evaluation-and-management, or E&M, care may finally be coming to an end. Recognizing that care coordination may hold the key to keeping healthcare costs in check for an aging population, the CMS last week proposed reimbursing doctors starting in 2015 for patient care-management activities that don't involve face-to-face contact.

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