Survey: 83% of providers see revenue declines due to CPT code cuts

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Since the Centers for Medicare & Medicaid Services' (CMS) decision to eliminate payments for consultation codes began Jan. 1, 83 percent of physicians said that total practice revenues have declined, and 30 percent said they have already cut back on services to Medicare patients, according to a survey of 5,500 physicians conducted by the American Medical Association (AMA) that was published June 25.

Thirty percent of the survey respondents said that over half of their patients are covered by Medicare, and one in three of the responding physicians said these services have been reduced due to the recent CMS decision.

Additionally, 39 percent said that they will suspend buying health IT or other equipment due to the elimination of the CPT codes, and one-third said the decisions will result in cuts to staff to make way for the cost-reductions. One-fifth of the responding physicians said that they have or plan to reduce appointments for Medicare patients because of the cuts.

The only CPT consultation codes not affected were those associated with telehealth.

Additionally, the CMS recommended that physicians bill Medicare services using the “most appropriate” evaluation and management codes—six percent of physicians said that they have stopped providing written reports, and 19 percent say they are considering stopping them.

Five percent of the survey respondents said that they have stopped accepting new Medicare patients altogether, seven percent stopped or reduced Medicare consultation patients referred by primary care physicians and 11 percent reduced the time spent with Medicare patients.

According to the AMA, the consultation code survey is part of its strategy, along with the American Group Management Association and 16 other societies including the Endocrine Society, the Heart Rhythm Society and the American College of Physicians, among others, to urge CMS to revise and rework the elimination of the CPT consultation codes within its 2011 rules.

In a June 18 letter to CMS, the societies cast doubts on CMS’ decision stating that in the 2010 physician payment rule, CMS voiced that no one specialty would see Medicare revenue declines of more than three percent. However, most specialties saw cuts higher than three percent.

“A review of CMS’s current policies regarding physician consultations is clearly called for,” the letter stated. “Revenue losses for consultant physicians are larger than projected. Physicians have been forced to reduce services to Medicare patients and care coordination has suffered as a result of the policy.”

These problems "could be mitigated by revising CMS guidelines regarding prolonged visits and new patients and/or by creating some mechanism for reimbursing consultant physicians for a comprehensive report back to a referring physician,” the letter concluded.