Analysis of 10-year trends in Medicare Physician Fee Schedule payments in surgery

BACKGROUND

Medicare expenditures have steadily increased over the decades, and yet Medicare Physician Fee Schedule payments for individual services have declined. We examine trends in Medicare Physician Fee Schedule payments for office visits, inpatient visits, and surgical procedures.

METHODS

The Medicare Physician Fee Schedule Look-Up Tool was queried for payment data for office visits, inpatient visits, and surgical procedures between 2013 and 2023. All data were adjusted for inflation using the Consumer Price Index. Trends in payments were calculated for 5 common procedures in each surgical specialty. Trends in aggregate national health expenditures were compared to Medicare Physician Fee Schedule payments for physician services from 2013 to 2021.

RESULTS

The Consumer Price Index increased by 29.3% from 2013 to 2023. Inflation-adjusted per-visit Medicare Physician Fee Schedule payments decreased by 12.2% for outpatient office visits, 19.1% for inpatient visits, and 22.8% for surgical procedures from 2013 to 2023. This varied by surgical specialty: vascular (-25.8%), endocrine (-22.0%), general surgery (-27.0%), thoracic (-19.2%), surgical oncology (-22.1%), breast (-22.4%), urology (-2.2%), neurosurgery (-22.8%), obstetrics/gynecology (-19.9%), and orthopedics (-24.7%). Adjusted for inflation, national health expenditures increased by 33.9% for physician services from 2013 to 2021. In comparison, Medicare Physician Fee Schedule payments over the same time period 2013 to 2021 increased by 1.3% for outpatient office visits but decreased by 10.6% for inpatient visits and 9.8% for surgical procedures.

CONCLUSION

Controlling rising national health expenditures is important and necessary, but 10 years of declining Medicare Physician Fee Schedule payments on a per-procedure basis in surgery would suggest that this strategy alone may not achieve those goals and could ultimately threaten access to quality surgical care. Surgeons must advocate for permanent payment reforms.

Hospital payment systems and physician reimbursement: A primer for radiology residents

Prior to practicing independently, radiology trainees spend considerable time and energy to learn and understand the practice of radiology. However, upon graduation trainees are often deficient in understanding the business of hospitals and the structure of reimbursement. Specifically, the workflow of relative value units (RVUs) and its impact on practice of radiology after completing training. In this manuscript, we provide a resource for trainees to understand the workflow of physician reimbursement. This article includes information on the mixed model healthcare structure of the United States and two government programs that influence reimbursement: Diagnosis-Related Groups (DRG) and Hospital Value-Based Purchasing (HVBP) programs. Furthermore, we explain the method by which the Center of Medicare and Medicate Service's (CMS) reimburses physicians via the Medicare Physician Fee Schedule (MPFS) using the Resource Based Relative Value Scale. Understanding the structure of these payments along with the challenges and current landscape of radiology reimbursement will help new radiologists prior to seeking employment where reimbursements are integral to contract expectations.

A Medicare Physician Fee Schedule Analysis of Reimbursement Trends in Laryngology from 2000 to 2021

OBJECTIVE

The purpose of this study is to characterize Medicare reimbursement trends for laryngology procedures over the last two decades.

METHODS

This analysis used CMS' Physician Fee Schedule (PFS) Look-Up Tool to determine the reimbursement rate of 48 common laryngology procedures, which were divided into four groups based on their practice setting and clinical use: office-based, airway, voice disorders, and dysphagia. The PFS reports the physician service reimbursement for "facilities" and global reimbursement for "non-facilities". The annual reimbursement rate for each procedure was averaged across all localities and adjusted for inflation. The compound annual growth rate (CAGR) of each procedure's reimbursement was determined, and a weighted average of the CAGR for each group of procedures was calculated using each procedure's 2020 Medicare Part B utilization.

RESULTS

Reimbursement for laryngology procedure (CPT) codes has declined over the last two decades. In facilities, the weighted average CAGR for office-based procedures was -2.0%, for airway procedures was -2.2%, for voice disorders procedures was -1.4%, and for dysphagia procedures was -1.7%. In non-facilities, the weighted average CAGR for office-based procedures was -0.9%. The procedures in the other procedure groups did not have a corresponding non-facility reimbursement rate.

CONCLUSION

Like other otolaryngology subspecialties, inflation-adjusted reimbursements for common laryngology procedures have decreased substantially over the past two decades. Because of the large number of physician participants and patient enrollees in the Medicare programs, increased awareness and further research into the implications of these trends on patient care is necessary to ensure quality in the delivery of laryngology care.

LEVEL OF EVIDENCE

NA Laryngoscope, 134:247-256, 2024.

The impact of changes in a physician fee schedule on medical expenditures, fees, and volume of services. Evidence from a national fee schedule reform in Australia

We examine the impact of changes to a national physician fee schedule on total medical expenditures, the volume of services, and fees charged. In our context, changes to the fee schedule were designed to promote value-based health care, and so included different types of changes to subsidised medical services, including changes to fees. Using claims data from a sample of doctors linked to a physician survey, we use difference-in-difference methods with a staggered adoption design to compare medical services which were affected with those which were not. We show that medical expenditures and the volume of affected services fell, though there is uncertainty about the magnitude of the fall. For GPs, we find evidence of increases in expenditures and fees and an increase in fees for some services provided by specialists.

Update on Dermatology Reimbursement in 2024

This article provides a discussion of the proposed Medicare physician fee schedule (MPFS) published by the Centers for Medicare & Medicaid Services (CMS) in July 2023, which will negatively impact dermatology practices starting in 2024. An overview of physician payment policy, legislative updates affecting dermatology, and the overall outlook for 2024 for dermatologists also is presented.

Budget Neutrality and Medicare Physician Fee Schedule Reimbursement Trends for Radiologists, 2005 to 2021

PURPOSE

The Medicare program, by law, must remain budget neutral. Increases in volume or relative value units (RVUs) for individual services necessitate declines in either the conversion factor or assigned RVUs for other services for budget neutrality. This study aimed to assess the contribution of budget neutrality on reimbursement trends per Medicare fee-for-service beneficiary for services provided by radiologists.

METHODS

The study used aggregated 100% of Medicare Part B claims from 2005 to 2021. We computed the percentage change in reimbursement per beneficiary, actual and inflation adjusted, to radiologists. These trends were then adjusted by separately holding constant RVUs per beneficiary and the conversion factor to demonstrate the impact of budget neutrality.

RESULTS

Unadjusted reimbursement to radiologists per beneficiary increased 4.2% between 2005 and 2021, but when adjusted for inflation, it declined 24.9%. Over this period, the conversion factor declined 7.9%. Without this decline, the reimbursement per beneficiary would have been 9 percentage points higher in 2021 compared with actual. RVUs per beneficiary performed by radiologists increased 13.1%. Keeping RVUs per beneficiary at 2005 levels, reimbursement per beneficiary would have been 12.1 percentage points lower than observed in 2021.

CONCLUSIONS

Given budget neutrality, a substantial decline has occurred in inflation-adjusted reimbursement to radiologists per Medicare beneficiary. Decreases due to both inflation and the decline in conversion factor are only partially offset by increased RVUs per beneficiary, meaning more services per patient with less overall pay, an equation likely to heighten access challenges for Medicare beneficiaries and shortages of radiologists.

Current Reimbursement Landscape of Artificial Intelligence

One of the biggest hurdles to widespread adoption of new procedures and technology such as artificial intelligence (AI) algorithms is payment and coverage policy. Noninvasive assessment of coronary fractional flow reserve is one AI imaging algorithm that will successfully achieve reimbursement through multiple pathways of CMS payment mechanisms in 2024. CMS is the largest provider of health care in the United States. Understanding how this AI algorithm is paid through the different fee schedules will help to understand the challenges CMS has in paying for new services and innovation in the United States.

Relative billing complexity of in-person versus telehealth outpatient encounters

RATIONALE

Video visits became more widely available during the coronavirus disease (COVID-19) pandemic. However, the ongoing role and value of video visits in care delivery and how these may have changed over time are not well understood.

AIMS AND OBJECTIVES

Compare the relative complexity of in-person versus video visits during the COVID-19 pandemic and describe the complexity of video visits over time.

METHODS

We used billing data for in-person and video revisits from non-behavioural health specialities with the most video visit utilisation (≥50th percentile) at a large, urban, public healthcare system from 1 January 2021 to 31 March 2022. We used current procedural terminology (CPT) codes as a proxy for information gathering and decision-making complexity and time spent on an encounter. We compared the distribution of CPT codes 99211-99215 between in-person and video visits using Fisher's exact tests. We used Spearman correlation to test for trends between proportions of CPT codes over time for video visits.

RESULTS

Ten specialities (adult primary care, paediatrics, adult dermatology, bariatric surgery, paediatric endocrinology, obstetrics and gynaecologist, adult haematology/oncology, paediatric allergy/immunology, paediatric gastroenterology, and paediatric pulmonology) met inclusion criteria. For each speciality, proportions of each CPT code for in-person visits and for video visits varied significantly, and patterns of variation differed by speciality. For example, in adult primary care, video visits had smaller proportions of moderate/high complexity visits (99214 and 99215) and greater proportions of lower complexity visits (99211-99213) compared with in-person visits (p < 0.001), but in paediatric endocrinology, the opposite was seen (p < 0.001). Trends in CPT codes over time for video visits in each speciality were also mixed.

CONCLUSION

In-person and video visits had differing proportions of complexity codes (typically skewing towards lower complexity for video visits). The complexity of video visits changed over time in many specialities. Observed patterns for both phenomena varied by speciality.

Tetralogy of Fallot: A case study and billing and coding perspective using the 2021 updated fee schedule

ABSTRACT

The Physician Fee Schedule was updated in 2021 by the Centers for Medicare and Medicaid Services. A case study on Tetralogy of Fallot, the most common cyanotic congenital heart defect, is presented with guidance in billing the office visit to reflect the current guidelines.

Reductions in Reimbursement and RVUs for Interventional Radiology Procedures: Trends from 2011 to 2021 Compared to Other Physician Specialties

PURPOSE

To compare recent trends in Medicare reimbursement and relative value units (RVUs) for interventional radiology (IR) procedures similar to those performed by non-IR specialties.

MATERIALS AND METHODS

Data from the CMS Physician Fee Schedule for facility reimbursement and RVU component values for 23 commonly performed single CPT IR procedures were compared to similar procedures or procedures for similar indications performed by non-IR specialties between 2011 and 2021.

RESULTS

The work RVU (wRVU) component decreased in 18 of 23 (78.3%) IR procedures compared to 6 of 23 (26.1%) similar procedures performed by non-IR specialties. The largest change in single RVU component was a 19.2% reduction in practice expense RVU for IR compared to a 16.5% reduction for similar procedures performed by non-IR specialties.

CONCLUSION

As a specialty, interventional radiology experienced a disproportionately greater reduction in reimbursement and RVU valuation for a range of comparable procedures performed by non-IR specialties.

Nurses' critical role in CPT code valuation

ABSTRACT

Relative value units (RVUs) are a measurement of practice efficiency and patient complexity. RVUs are reviewed by the Centers for Medicare and Medicaid Services through the Resource-Based Relative-Value Scale Update Committee, which determines recommendations regarding the Current Procedural Terminology code valuations for the Medicare Physician Fee Schedule. This article discusses the importance of nurses' participation in the accurate valuation of their work and in the process of developing and revising RVUs.

Patient Safety Activity Under the Social Insurance Medical Fee Schedule in Japan: An Overview of the 2010 Nationwide Survey

OBJECTIVES

Little is known about patient safety performance under the social insurance medical fee schedule in Japan. The Health Ministry in Japan introduced the preferential patient safety countermeasure fee (PPSCF) to promote patient safety in 2006 and revised the PPSCF system in 2010. This study aims to address the patient safety performance status at hospitals implementing the PPSCF.

METHODS

A nationwide questionnaire survey targeting 2674 hospitals with the PPSCF was performed in 2010 to 2011. The 627 participant hospitals were divided into the following three groups: 178 hospitals implementing PPSCF 1 with 400 beds or more (group A), 286 hospitals implementing PPSCF 1 with 399 beds or fewer (group B), and 163 hospitals implementing PPSCF 2 (group C).

RESULTS

The mean numbers (standard errors) of patient safety managers were 1.45 (0.07) in group A, 1.12 (0.04) in group B, and 0.37 (0.12) in group C (P < 0.001). The participation number and rates of all staff for the patient safety seminar were 1721 (167) and 1.64 (0.10) in group A, 580 (26) and 1.94 (0.09) in group B, and 349 (31) and 1.98 (0.17) in group C (P < 0.001, P = 0.105).These results can be explained because hospitals with PPSCF 1 (groups A and B) must assign at least one full-time patient safety manager, whereas hospitals with PPSCF 2 (group C) are not required to do so. Patient safety performance at hospitals with PPSCF 1 was more active than that at hospitals with PPSCF 2. However, when the values were converted to per capita or per 100 beds, there were no differences across the three groups.

CONCLUSIONS

The PPSCF encourages hospitals to perform actions for patient safety by providing incentives under the social insurance medical fee schedule in Japan.

Projections of the Impact to Arthroplasty Surgeons With Changes to the 2021 Medicare Physician Fee Schedule-A Looming Crisis of Access to Care?

BACKGROUND

The Centers for Medicare and Medicaid Services 2021 Physician Fee Schedule (PFS) includes increases in office reimbursement but decreases in the valuation of total hip arthroplasty and total knee arthroplasty and the conversion factor. The purpose of this study was to determine the financial impact of these changes on arthroplasty surgeons.

METHODS

We queried data for 35 arthroplasty surgeons within our practice from 10/2019 to 10/2020 and captured all office and arthroplasty-related surgical procedure codes. We compared the difference in both work relative value units (RVUs) and Medicare reimbursement by surgeon based on the current 2020 PFS to the 2021 changes. We also estimated the impact of several proposals to include office increases to the global surgical package for each code.

RESULTS

While the mean per surgeon RVU amount for primary arthroplasty procedures will decrease (6267 vs 6,088, P = .78), the mean office work RVU (2755 vs 3,220, P = .16) will increase in 2021. However, the reduction in surgical reimbursement ($530,076 in 2020 to $464,414 in 2021) far exceeds the gains from the office ($99,456 vs $107,374), leading to an overall decrease in reimbursement ($629,532 vs $571,788), a reduction of 9%. The passage of the coronavirus disease 2019 relief bill delays many of the PFS cuts and will result in an overall reduction in reimbursement of 2.4% ($629,532 vs $612,475, P = .61).

CONCLUSION

Arthroplasty surgeons are projected to lose 2.4% of Medicare reimbursement in 2021 with the changes in the Centers for Medicare and Medicaid Services PFS. Further study is needed to determine whether these cuts will limit access to care for Medicare patients.

Medicare Advantage for Most

Policy Points Fixing the ACA requires real cost containment in addition to better subsidies. Private Medicare (Medicare Advantage) plans are uniquely empowered to control costs and deliver good care. Medicare Advantage plans should serve as the public option on the ACA Marketplace. Medicare Advantage plans can also be deployed to voluntarily raise minimum employer-sponsored benefits and contain their costs.

Fee-for-service payment is not the (main) problem

OBJECTIVE

To understand the effect of physician payment incentives on the allocation of health care resources.

DATA SOURCES/STUDY SETTING

Review and analysis of the literature on physician payment incentives.

STUDY DESIGN

Analysis of current physician payment incentives and several ways to modify those incentives to encourage increased efficiency.

PRINCIPAL FINDINGS

Fee-for-service payments can be incorporated into systems that encourage efficient pricing - prices that are close to the provider's marginal cost - by giving consumers information on provider-specific prices and a strong incentive to choose lower cost providers. However, efficient pricing of services ultimately will need to be supplemented by incentives for efficient production of health and functional status.

CONCLUSIONS

The problem with current FFS payment is not paying a fee for each service, per se, but the way in which the fees are determined.

Running Out of Reasons: Low Payments, Hassles Leave Physicians Wondering: Why stay in Medicare?

Texas physicians who deal with Medicare's substandard payments and world-class administrative hassles are feeling underappreciated. The latest report from the committee that advises Congress on Medicare payment policy may exacerbate that feeling. In March, the Medicare Payment Advisory Committee (MedPAC) released its annual report assessing payments to physicians, among other sectors. MedPAC recommended no changes to the 2021 Medicare physician fee schedule, meaning no increase in physician payments.

Impact of a national medical fee schedule revision on the cessation of physician home visits among older patients in Tokyo: A retrospective study

As Japan's population continues to age rapidly, the national government has implemented several measures to improve the efficiency of healthcare services and to control rising medical expenses for older patients. One such measure was the revision of the medical fee schedule for physician home visits in April 2014, in which eligibility for these visits was restricted to patients who are unable to visit outpatient clinics without assistance. Through an investigation of patients who were receiving physician home visits in Tokyo, this study examines whether this fee schedule revision resulted in an increase in patients who transitioned from home visits to outpatient care. In a retrospective analysis of health insurance claims data, we examined 80,914 Tokyo residents aged 75 years or older who had received at least one physician home visit between January and May 2014. The study period was divided into four periods (January-February, February-March, March-April, and April-May), and we examined the number of patients receiving home visits in the index month of each period who subsequently transitioned to outpatient care in the following month. Potential factors associated with this transition to outpatient care were examined using a generalised estimating equation. The March-April period that included the fee schedule revision was significantly associated with a higher number of patients who transitioned from home visits in the index month to outpatient care in the following month (odds ratio: 4.46, p < 0.001) than the other periods. In addition, patients receiving home visits at residential facilities were more likely to transition to outpatient care (odds ratio: 10.40, p < 0.001). These findings indicate that the fee schedule revision resulted in an increase in patients who ceased physician home visits and began visiting outpatient clinics for treatment.

Accuracy of Valuations of Surgical Procedures in the Medicare Fee Schedule

BACKGROUND

The Relative Value Scale Update Committee (RUC) of the American Medical Association plays a central role in determining physician reimbursement. The RUC's role and performance have been criticized but subjected to little empirical evaluation.

METHODS

We analyzed the accuracy of valuations of 293 common surgical procedures from 2005 through 2015. We compared the RUC's estimates of procedure time with "benchmark" times for the same procedures derived from the clinical registry maintained by the American College of Surgeons National Surgical Quality Improvement Program (NSQIP). We characterized inaccuracies, quantified their effect on physician revenue, and examined whether re-review corrected them.

RESULTS

At the time of 108 RUC reviews, the mean absolute discrepancy between RUC time estimates and benchmark times was 18.5 minutes, or 19.8% of the RUC time. However, RUC time estimates were neither systematically shorter nor longer than benchmark times overall (β, 0.97; 95% confidence interval, 0.94 to 1.01; P = 0.10). Our analyses suggest that whereas orthopedic surgeons and urologists received higher payments than they would have if benchmark times had been used ($160 million and $40 million more, respectively, in Medicare reimbursement in 2011 through 2015), cardiothoracic surgeons, neurosurgeons, and vascular surgeons received lower payments ($130 million, $60 million, and $30 million less, respectively). The accuracy of RUC time estimates improved in 47% of RUC revaluations, worsened in 27%, and was unchanged in 25%. (Percentages do not sum to 100 because of rounding.).

CONCLUSIONS

In this analysis of frequently conducted operations, we found substantial absolute discrepancies between intraoperative times as estimated by the RUC and the times recorded for the same procedures in a surgical registry, but the RUC did not systematically overestimate or underestimate times. (Funded by the National Institutes of Health.).

New diagnostic procedure codes and reimbursement

With the implementation of the new Medicare Physician Fee Schedule on January 1, 2019, it can be beneficial for all practitioners to grasp an understanding of how reimbursement is determined. With the new Physician Fee Schedule also came new relative value units (RVUs) and new billing codes. Biopsy codes, in particular, were changed to reflect the complexity of the sampling technique (ie, tangential, punch, incisional). In this article, we explain RVUs and how they determine reimbursement. This article also highlights changes and additions to billing codes, specifically for biopsies and telemedicine services.

Reframing Medicare Physician Payment Policy for 2019: A Look at Proposed Policy

On July 12, 2018, the Centers for Medicare and Medicaid Services (CMS) released the proposed 2019 Medicare physician fee schedule and quality payment program, combining these 2 rules for the first time. This occurred in a milieu of changing regulations that have been challenging for interventional pain management specialists. The Affordable Care Act (ACA) continuous to be amended by multiple administrative changes. This July 12th rule proposes substantial payment changes for evaluation and management (E&M) services, with documentation requirements, and blending of Level II to V CPT codes for E&M into a single payment. In addition, various changes in the quality payment program with liberalization of some metrics have been published. Recognizing that there are differing impacts based on specialty and practice type, as a whole interventional pain management specialists would likely see favorable reimbursement trends for E&M services as a result of this proposal. Moreover, in comparison with recent CMS final ruling, this proposed rule has relatively limited changes in procedural reimbursement performed in a facility or in-office setting.CMS, in the new rule, has proposed an overhaul of the E&M documentation and coding system ostensibly to reduce the amount of time physicians are required to spend inputting information into patients' records. The new proposed rule blends Level II to V codes for E&M services into a single payment of $93 for office outpatient visits for established patients and $135 for new patient visits. This will also have an effect with blended payments for services provided in hospital outpatients. CMS also has provided additional codes to increase the reimbursement when prolonged services are provided with total reimbursement coming to Level V payments. Interventional pain management-centered care has been identified as a specialty with complexity inherent to E&M associated with these services. Among the procedural payments, there exist significant discrepancies for the services performed in hospitals, ambulatory surgery centers (ASCs), and offices. A particularly egregious example is peripheral neurolytic blocks, which is reimbursed at 1,800% higher in hospital outpatient department (HOPD) settings as compared with procedures done in the office. The majority of hospital based procedures have faced relatively small cuts as compared with office based practice. The only significant change noted is for spinal cord stimulator implant leads when performed in office setting with 19.2% increase. However, epidural codes, which have been initiated with a lower payment, continue to face small reductions for physician portion.This review describes the effects of the proposed policy on interventional pain management reimbursement for E&M services, procedural services by physicians and procedures performed in office settings.

KEY WORDS

Physician payment policy, physician fee schedule, Medicare, Merit-Based Incentive Payment System, interventional pain management, regulatory tsunami, Medicare Access and CHIP Reauthorization Act of 2015.

Fee-for-Service Is Dead. Long Live Fee for Service?

The move to a value-based payment system was supposed to end perverse incentives that pay doctors more for delivering often unnecessary services. But things are changing slowly and the market is still 95% fee for service. There's talk of reworking the Medicare fee schedule so docs are paid more for the things that work, and less for those that don't.

How Medicare preventive services can bolster the hospital-physician enterprise

Medicare preventive services offer hospital-owned physician practices an opportunity to increase revenue.

Early View of Off-Campus Hospital Department Medicare Payments

Although off-campus departments account for a small percentage of outpatient revenue, the number could be underreported.

Proposed Medicare Physician Payment Schedule for 2017: Impact on Interventional Pain Management Practices

The Centers for Medicare and Medicaid Services (CMS) released the proposed 2017 Medicare physician fee schedule on July 7, 2016, addressing Medicare payments for physicians providing services either in an office or facility setting, which also includes payments for office expenses and quality provisions for physicians. This proposed rule occurs in the context of numerous policy changes, most notably related to the Medicare Access & CHIP Reauthorization Act of 2015 (MACRA) and its Merit-Based Incentive Payment System (MIPS). The proposed rule affects interventional pain management specialists in reimbursement for evaluation and management services, as well as procedures performed in a facility or in-office setting.Changes in the proposed fee schedule impacting interventional pain management practices include adjustments to the meaningful use (MU) program, care management in patient-centered services, identification and review of potentially misvalued services, evaluation of moderate sedation services, Medicare telehealth services, updated geographic practice cost index, data collection on resources used in furnishing global services, reporting of modifier 25 for zero day global services, Medicare Advantage Part C provider and supplier enrollment, appropriate use criteria (AUC) for advanced imaging services, and Medicare shared savings programs. The proposed schedule has provided rates for new epidural codes with or without imaging (fluoroscopy or computed tomography [CT]) and a fee schedule for a new code covering endoscopic spinal decompression. Review of payment rates show major discrepancies in payment schedules with high payments for hospitals, 2,156% higher than in-office procedures. Some procedures which were converted from in-office settings to ambulatory surgery centers (ASCs) are being reimbursed at 1,366% higher than ASCs. The Medicare Payment Advisory Commission (MedPAC) recommendation on avoiding the discrepancies and site-of-service differentials in in-office settings, hospital outpatient settings, and ASCs has not been agreed to by CMS. Thus, even though the changes appear to be minor in physician services and in-office service payment, these changes cumulatively have been reducing payments for interventional procedures. Further, in-office reimbursement is overall significantly lower than ASCs and hospital outpatient departments (HOPDs) specifically for intraarticular injections, peripheral nerve blocks, and peripheral neurolytic injections. The significant advantage also continues for hospitals in their reimbursement for facility fee for evaluation and management services.This health policy review describes various issues related to health care expenses, health care reform, and finally its effects on physician payments for all services and also for the services provided in an office setting.

Health Partners of Western Ohio: Integrated Care Case Study

Health centers are unique health care delivery organizations in which multiple disciplines, such as primary care, dental, behavioral health, pharmacy, podiatry, optometry and alternative medicine, are often located at the same site. Because of this characteristic, many health centers have developed systems of integrated care. This paper describes the characteristics of health centers and highlights the integrated health care delivery system of one early adopter health center, Health Partners of Western Ohio.

The Changing Face of Healthcare: 2016 CPT Changes and Beyond

This article reviews the changes to CPT 2016, with emphasis on the way CPT services will be provided in the future. Some of the newer codes are designed for reimbursable services provided by the medical clinical staff. In addition to the CPT changes, there are changes to the Medicare fee-for service Physician Fee Schedule. Review of these changes provides the reader with a snapshot of how healthcare will be provided and reimbursed in the future.

Medicare Physician Fee Schedule Ends at Age 26: Succeeding in an Era of Payment Reform

The Medicare Access and CHIP Reauthorization Act of 2015 solidifies healthcare payment reform by signaling the death of traditional fee-for-service reimbursement for providers. Effective 2019, Medicare payments will rely heavily on data, risk-sharing, and transparency to advance value over volume. Other payers will follow.

R.I.P. SGR

Medicine's united voice was instrumental in successfully repealing the flawed Medicare Sustainable Growth Rate (SGR) formula--a payment design enacted in 1997 to sustain Medicare with lower costs but that instead threatened physicians with unsustainable payment cuts every year since 2003. Doctors say the elimination of SGR frees medicine to advocate for other lingering issues affecting Medicare.