WASHINGTON – The American Academy of Family Physicians has stated that it “strongly opposes" the Senate amendment introduced by Sen. Arlen Specter (D-Pa.) which would postpone implementation of the CMS 2010 fee schedule.

The implementation is expected to begin to pay appropriately for the medical services provided to patients, end wasteful spending of limited resources, and strengthen primary care, which has been shown to be the foundation of a high quality healthcare system.

The AAFP contends that the CMS rule eliminates consultation codes and redistributes savings to all evaluation and management office visits. As a result, payment for office visits would increase by 6 percent.

Officials also say that the amendment would prolong the kind of wasteful spending cited in the 2006 Office of the Inspector General report, "Consultations in Medicare: Coding and Reimbursement."

The report found that, of services billed as consultations and allowed by Medicare:

• 19 percent or $191 million in payments did not meet Medicare’s definition of a consultation;
• 47 percent or $613 million in payments were billed as the wrong type or level of consultation; and
• 9 percent or $260 million in payments were not substantiated by documentation.

The amendment is also expected to extend Medicare payment for nonexistent services. Data indicate that consultation codes pay for appointments with specialists that are comparable to office visits conducted by primary care physicians.

Originally, higher payment under consultation codes was designed to compensate for the additional reports consulting physicians were required to send to the referring physician. As these reports are no longer required, the additional payment should no longer be justified.

AAFP said that postponing implementation of the CMS fee schedule and rule would permit erosion and inefficiency to primary care to continue by maintaining current payment policies.