Rheumatologists Applaud Long-Awaited Updates to Cognitive Care Reimbursement in Medicare Physician Fee Schedule Final Rule

The American College of Rheumatology (ACR) commends the Centers for Medicare & Medicaid Services (CMS) for making long-awaited updates to cognitive care reimbursement in its CY 2021 Medicare Physician Fee Schedule (MPFS) final rule.

The final rule provides much-needed increases in Medicare reimbursement for the evaluation and management (E/M) services provided by rheumatologists and other cognitive care specialties to Medicare beneficiaries. Healthcare services billed under E/M codes include examinations, disease diagnosis, risk assessments and care coordination.

“For many years, Medicare reimbursement did not adequately reflect the time and skill required to provide high-quality cognitive care, including rheumatology care,” said David Karp, MD, PhD, president of the ACR. “These updates are critical to the future of the rheumatology specialty and the continued delivery of high-quality rheumatology care for millions of Medicare beneficiaries.” 

In 2018, CMS proposed a code collapse that would have resulted in significant cuts to rheumatology care provided to Medicare beneficiaries. However, after hearing the concerns raised by the patient and specialty provider community, CMS finalized a new proposal that reflects the recommendations of the American Medical Association, the ACR and over 170 other specialty societies and state medical associations.

The reimbursement updates will go into effect on January 1, 2021.

“These E/M improvements are the result of years of advocacy by rheumatologists and patients that educated policymakers about the importance of time spent with patients for chronic disease management,” said Blair Solow, MD, chair of the ACR’s Government Affairs Committee. “We commend CMS for recognizing the value of the care provided by rheumatologists and rheumatology health professionals.” 

To ensure that long overdue E/M rate increases do not lead to rate cuts to other medical specialties including physical and occupational therapists, the ACR is also leading advocacy efforts in support of H.R. 8505, legislation that would provide for a one-year waiver of budget neutrality adjustments. In November, the ACR led more than 60 groups in sending a letter to Congressional leaders urging them to support the bipartisan legislation, which was introduced by Representatives Michael Burgess (R-TX) and Bobby Rush (D-IL).

“Budget neutrality via H.R. 8505 is a fair and reasonable approach to ensure needed cognitive care updates are not made at the expense of other specialties. We encourage congressional leaders to swiftly pass this legislation,” said Solow.

 # # # 

The American College of Rheumatology (ACR) is an international medical society representing over 8,500 rheumatologists and rheumatology health professionals with a mission to empower rheumatology professionals to excel in their specialty. In doing so, the ACR offers education, research, advocacy and practice management support to help its members continue their innovative work and provide quality patient care. Rheumatologists are experts in the diagnosis, management and treatment of more than 100 different types of arthritis and rheumatic diseases.