Drs. Robert A. Benson and John D. Goodson, writing for the New England Journal of Medicine, emphasized the importance of the Medicare Physician Fee Schedule (MPFS), particularly as it pertains to the industry shift from fee-for-service to value-based systems:
What payment reformers often fail to recognize is that the specific MPFS payment rates have important implications for Medicare and its beneficiaries. The relative payment levels for the thousands of service codes and the absence of payment for other activities powerfully influence how physicians spend their time — and their tendency to perform unneeded tests and procedures. The mix of services that physicians provide under a particular fee schedule can affect value at least as much as any improvements derived from rewarding physicians on the basis of quality measures.
Benson and Goodson further point out that many nonprocedural physician activities, known as evaluation and management (E/M) services, aren’t fully represented in the MPFS, and other tasks are often “upcoded” due to ambiguity within the fee schedule. The authors suggest policymakers gain “a more nuanced understanding” of these services to determine how to compensate physicians for them based on their specialties and the amount of work they require.
After all, say Benson and Goodson, any weakness in the MPFS will impact new policies:
Because the MPFS is the foundation of new payment methods, its deficiencies will reverberate through them. Payment reform will be more likely to achieve its aims if there’s a transparent, accountable, dynamic process for determining the resources required for various services and assurance that we’ve accounted for the cognitive aspects of care while addressing coding ambiguities.