Presentation Authors: Parth K. Modi*, Samuel R. Kaufman, Vahakn B. Shahinian, Brent K. Hollenbeck, Ann Arbor, MI
Introduction: Office evaluation and management (E&M) visits are the most common physician services and accounted for approximately $23 billion in Medicare spending in 2017. Currently, these visits are reimbursed according to visit complexity at 5 levels. Recently, the Centers for Medicare & Medicaid Services has proposed setting one payment level for all level 2 through 5 visits. This change, they propose, will help simplify billing and documentation, reduce the potential for fraud, and have only a minor impact on physician reimbursement. However, the impact on different types of physician practices is not known. Therefore, we aimed to assess the effect of this policy change on Medicare reimbursement for urology practices.
Methods: Using a 20% sample of national Medicare claims data linked with the Medicare Data on Provider Practice and Specialty file, we identified all group practices with at least one urologist in 2015. For each group, we characterized group practice type (solo, single specialty, or multispecialty) and academic affiliation. For each practice, we examined all office E&M visits and calculated current payments as well as hypothetical payments under the proposed policy. We then determined the change in each practice&[prime]s Medicare revenues and used multiple linear regression to identify predictors of decreased revenues.
Results: We identified 2,822 practices: 1,033 (36.6%) were multispecialty groups, 1,372 (48.6%) were solo groups, and 417 (14.8%) were single specialty urology groups. As a result of the E&M payment change, half of urology practices would earn at least 1.3% higher Medicare revenues. However, there was considerable variation, with the potential impact ranging from -42% to 56% of total Medicare professional fees. In total, 37.6% of practices would have reduced Medicare revenues and 11.7% of practices would lose more than 5% of their Medicare payments for the year. Academic medical groups were primarily multispecialty groups and accounted for 116 (4.1%) practices. The majority of academic medical groups (63.8%) would have reduced revenues (Figure).
Conclusions: On average, urology practices stand to benefit from the proposed change to E&M reimbursement. However, groups with a high proportion of level 4 and 5 office visits, particularly academic medical groups, will have significantly diminished Medicare revenues.
Source of Funding: This work was supported by NIA R01AG048071 (BKH) and NCI F32CA232332 (PKM)