Wenstrup, Blackburn lead bipartisan letter requesting options for proposed Medicare change

U.S. Reps. Brad Wenstrup (R-OH) and Marsha Blackburn (R-TN) led 87 U.S. House members in calling on the Centers for Medicare and Medicaid Services (CMS) to take more time to develop alternatives to a proposed CMS rule change that they think could negatively impact how America’s physicians get reimbursed.

“I applaud CMS’s efforts to reduce the administrative burden on health care providers, and want to make sure we get it right as we take concrete steps in that direction,” Rep. Wenstrup said in a Sept. 11 statement.

“By taking additional time, and working with physicians, CMS can be most effective in reducing the crushing paperwork experienced by doctors while ensuring patients get the care they need,” said the congressman.

The proposed CMS rule for the Medicare 2019 Physician Fee Schedule (PFS) would consolidate existing evaluation and management payment services codes by Jan. 1 2019 to reduce administrative paperwork and related duties, according to a Sept. 7 letter the lawmakers sent to CMS Administrator Seema Verma.

However, the House members said the consolidation proposal specifically would create add-on fee codes that, in turn, would actually generate more paperwork for some doctors, such as oncologists, rheumatologists, ophthalmologists, neurologists, and endocrinologists, among other specialists who treat patients having complex conditions.

Subsequently, the additional codes for the evaluation and management payment rates “will undermine the underlying, positive intent of the proposed rule to reduce administrative burden on clinicians,” the lawmakers wrote.

The congressmen noted concern that the CMS proposed rule “devalues the expertise, clinical decision-making, and time of physicians who treat patients with complex conditions,” and could negatively impact faculty physicians at the nation’s largest teaching hospitals who treat the majority of such patients.

“Additionally, it is our understanding that this proposal was created with little consultation with affected stakeholders, and we have heard significant concerns from constituent physicians of all specialties who are concerned with the potential effects this proposal may have on their patients and practices,” according to the letter.

The House lawmakers said they appreciated and commended “the good intentions” behind the CMS proposed rule change, but urged the agency to take more time, work more closely with physicians and other stakeholders, and identify alternative approaches “that would accomplish CMS’ goals while ensuring that physicians are reimbursed appropriately.”

U.S. Reps. Doris Matsui (D-CA) and Earl Blumenauer (D-OR) joined Reps. Blackburn and Wenstrup in spearheading the letter.