Court issues ruling on key E/M services payments issue

The American Medical Association (AMA) reports that the U.S. Court of Appeals-D.C. Circuit has overturned a key district court decision that gave the U.S. Department of Health and Human Services (HHS) “the authority to cut payments to off-campus provider-based departments for E/M services to make them equivalent to the rate paid to physician offices in 2019.”

AMA also notes that, “The AHA, AAMC, and the other plaintiffs have not yet said whether they will appeal. Separately, they are suing [the Centers for Medicare & Medicaid Services] for the 2020 site neutral pay cuts.”

In a letter that it sent to HHS in September 2019, AMA reiterated that “[while] the AMA generally supports site neutral payments, [it does] not believe that it is possible to sustain a high-quality health care system if site neutrality is defined as shrinking all payments to the lowest amount paid in any setting.”

AMA also “believes that payment differentials between independent physician practices and hospital outpatient departments stem in part from inadequate Medicare physician payment rates – after adjustment for inflation, Medicare physician pay has declined 20 percent since 2001 – and that any savings from site neutrality proposals derived from OPPS should be reinvested in improvements elsewhere in Part B, including payments to physicians.”

U.S. Court of Appeals ruling

AMA letter to HHS (September 2019)

Medicare site neutral payment policy summary