AAFP: CMS needs to place higher value on primary care services

January 26, 2011

The majority of family physicians will qualify to receive bonuses through the Centers for Medicare and Medicaid Services' (CMS) Primary Care Incentive Program (PCIP). Nevertheless, CMS is coming under harsh criticism from the American Academy of Family Physicians (AAFP) for not doing more to ensure that primary care doctors are appropriately valued and reimbursed for their work.

 

The majority of family physicians will qualify to receive bonuses through the Centers for Medicare and Medicaid Services' (CMS) Primary Care Incentive Program (PCIP). Nevertheless, CMS is coming under harsh criticism from the American Academy of Family Physicians (AAFP) for not doing more to ensure that primary care doctors are appropriately valued and reimbursed for their work.

AAFP's Board Chair Lori Heim, MD, wrote in a letter to CMS that primary care doctors are being sold short for the work involved in counseling patients for combination vaccinations, since the relative value units (RVUs) are taken from old CPT coding structures that don't reflect the work associated with counseling. The American Medical Association/Specialty Society Relative Value Update Committee (RUC) has recommended assigning higher values to these codes.

The addition of three CPT codes allows primary care doctors to be reimbursed for subsequent observation services in a facility setting, but Heim contends the codes do not go far enough to adequately reflect the recent increase in the need for such services. She says the valuation of these codes is not in line with the RUC's recommendations to assign RVUs that are equal to those associated with subsequent inpatient care.

CMS also reviewed and made changes to maternity care CPT codes that devalued these services, despite RUC recommendations to significantly increase the values.

"Unfortunately, it is action such as this that contributes to a sense among our members that CMS continues to underappreciate and therefore undervalue the work that primary care physicians in general and family physicians in particular provide," Heim wrote.