AMA Protest Convinces HHS Secretary To Review Usefulness of E&M Guides

Burdensome, confusing, and flawed were some of the adjectives an AMA coalition of physician groups used to describe the latest attempt to develop new evaluation and management (E&M) documentation guidelines for the Medicare program.

APA and 38 other physician groups signed a June 29 letter from the AMA asking Thomas Scully, administrator of the federal government’s Centers for Medicare and Medicaid Services (CMS), to reconsider the burden that the new guidelines and the “clinical examples” accompanying them would impose on physicians.

(The Centers for Medicare and Medicaid Services is the new name for the Health Care Financing Administration [HCFA].)

The AMA complained that the previous E&M guidelines issued in 1995 and 1997 have hindered rather than helped the delivery of appropriate patient care. The guidelines are intended to help physicians know how to bill Medicare for their patients’ visits.

The AMA recommended that the clinical examples in the new draft E&M guidelines be scrapped because they are inconsistent, irrelevant to typical physician-patient encounters, and based on inappropriate clinical terminology. They also would require more documentation.

AMA called on CMS to reassess the need and value of having E&M documentation guidelines and clinical examples.

Apparently, the AMA letter had an impact because HHS Secretary Tommy Thompson announced in testimony last month before the House Ways and Committee and the Senate Finance Committee that he has put the draft E&M guidelines on hold.

“We had hoped that this current effort would reduce the burden on physicians, but it appears to need another look,” testified Thompson. He asked Aspen Systems, the CMS contractor, to stop work on the current draft while CMS reassesses its effort.

Thompson said he is looking to the physician community to help design constructive solutions. “After six years of confusion, I think it makes sense to go back and re-examine the actual codes for billing doctors’ visits,” testified Thompson.

He mentioned that he looked forward to working with the AMA and other physician groups to simplify the codes and make them as understandable as possible.

To facilitate this process, Scully announced that a new physician committee will be formed and chaired by CMS Deputy Administrator Reuben King Shaw. This is one of seven health care committees that will meet monthly to “provide a better understanding of CMS and improve our policy feedback. The committees will also generate ideas for programs improvements and reform,” said Scully in a statement last month.

The other six health care committees represent hospitals and rural health, nursing homes, health plans, nurses and allied health care professionals, home health and hospices, and dialysis centers. ▪