Starting a proper thread on the 2021 physician fee schedule for the revaluation of the E&M. The largest increase in primary care reimbursement in two decades. 1/

Since the RVU concept was created procedure codes have both proliferated in number and their initial valuations have been sticky so efficiencies are captured as profits to proceduralists instead of coming down as costs have come down 2/

While E&M is basically the same codes it always has been. Years ago the AMA RUC did a survey to determine the time and complexity of E&M in modern times and found pre and post visit time undervalued significantly (insert the duh from any practicing primary care doc). 3/

CMS has been talking about this for over 3 years now in the physician fee schedule rules. Why wait so long? Cause of budget neutrality. They have to rob Paul to pay Peter. 4/

Some $ comes from the aforementioned bloat in procedure codes and valuations, but a lot of it does not so CMS gave Congress as a lot of time to act, but it didn’t. This created a belief (correct in my view) that Congress would only fix a problem once it existed not before 5/

So after years of waiting CMS bravely went ahead with the most up to date valuations and let the budget neutrality chips fall where they may. Congress is now interested. https://www.congress.gov/bill/116th-congress/house-bill/8505?s=3&r=1 but does have little time to act. Note Congress can make changes retroactively 6/

How big of a deal is this? Our analysis of primary care practices in our ACOs shows an average increase in overall reimbursement from PFS of 9%. A little more info on the practices in our ACOs. https://www.aledade.com/practice-results 7/

It is important to note that this isn’t a raise in a traditional sense. For the last few years CMS has known they are underpaying by 9% and not doing anything about it hoping Congress would step in. The ball now shifts up the street to Capital Hill. 8/