September 11, 2017
Centers for Medicare & Medicaid Services
Department of Health and Human Services
Attention: CMS–1676–P Mail Stop C4–26–05
7500 Security Boulevard
Baltimore, MD 21244–1850
To Whom It May Concern:
The American College of Occupational and Environmental Medicine (ACOEM) welcomes the opportunity to provide comments to the Centers for Medicare and Medicaid Services (CMS) regarding proposed revisions to the Medicare physician fee schedule (PFS) and other Medicare Part B payment policies. ACOEM represents more than 4,200 physicians and other health care professionals who specialize in occupational and environmental medicine (OEM). ACOEM is the nation’s largest medical society dedicated to promoting the health of workers through preventive medicine, clinical care, disability management, research, and education
ACOEM concurs with CMS that the Evaluation and Management (E/M) Guidelines are overdue for an overhaul. ACOEM applauds CMS' intention to use coding rules to improve medical decision-making. We support developing coding rules that align with risk reduction and outcome improvement. We believe that coding changes that include a focus on patient risk and health care outcome will foster better medical decision making.
Medical care should be focused on more than symptom reduction — ideally medical encounters support the restoration of normal life activities, including participation in school, work, family, and society. Attending to FUNCTION as a vital sign would increase the value of medical care in every clinical setting, including urgent care, primary care, specialty care, and workers’ compensation related encounters.
E/M coding should encourage providers to evaluate patients for risk of poor functional outcomes. Medical documentation should include risk mitigation plans. We recommend including mechanisms to measure, capture and reimburse for documenting: a) Assessment of functional progress and functional outcomes, rather than simply the presence of pain or other symptoms; b) Assessment of risk factors, including comorbidities, that warn of possible delayed recovery, risk for medical excess or suboptimal participation in life (whether that be work, school, family or community); c) Communication with other stakeholders whose understanding of the patient’s case status will be important for good clinical outcomes.
For the past five years, an ACOEM task force has been developing proposed coding changes that would encourage medical decision-making that documents an improved focus on risk and functional outcomes. Attached is the work of the ACOEM task force — ACOEM Proposed Alternative Coding Criteria. Such improvements in the quality of medical decision-making and documentation quality are relevant to all systems involving treatment, liability or disability issues, including Medicare and Social Security disability.
All U.S. medical documentation, coding, billing and auditing systems are built on the same CMS-established foundation, regardless of whether CMS is the payer for the care. The changes now contemplated by CMS will therefore affect all US medical providers and their patients.
ACOEM would welcome the opportunity to participate in the CMS review process. We offer CMS our assistance, as a medical specialty dedicated to reduction of risk and the recovery of function. While our principal focus is occupational and environmental in nature, our advice — through our published evidence-based guidelines — is sought and utilized by diverse medical specialties dealing with the prevention of harm and the improvement in function. If you should have any questions or need additional information, please call Patrick O’Connor, ACOEM’s Director of Government Affairs, at 703-351-6222.
Thank you for your consideration.
Charles M. Yarborough III, MD, MPH, FACOEM