Endocrine Society Supports Proper Specialty Care Reimbursement

As the Centers for Medicare and Medicaid Services (CMS) begins the process to transition physician payment from a system that pays by volume to one that pays for value, the Endocrine Society continues to have concern that new payment models properly value cognitive services and not only focus on procedures. As a result, the Endocrine Society has joined with other specialty societies who treat patients many with multiple, concurrent, complex acute, and chronic conditions that require complicated diagnostic strategies and non-procedural treatments to create a new coalition, the Cognitive Care Alliance, to recognize cognitive care.

“We have lost an alarming number of those physicians able to deal with the cognitive complexities of modern medical practice due to relative underpayment.” — John Goodson, MD, chair, Cognitive Care Alliance

The Alliance has united physicians who practice primary care, rheumatology, gastroenterology, neurology, and endocrinology and are concerned that the relative pricing for the complex and ongoing purely cognitive services they provide do not accurately capture the intensity of the work and the value provided to the health care system.

“It is essential that the physician workforce represents the thinking as well as the doing traditions of medicine. We have lost an alarming number of those physicians able to deal with the cognitive complexities of modern medical practice due to relative underpayment,” Says John Goodson, MD, chair, Cognitive Care Alliance. “We can no longer afford to be complacent and have joined together to become a united voice advocating for a national, independent survey of physician cognitive work and the creation of a revised payment structure that ensures a robust and balanced physician workforce in the future.”

The Alliance was formed to ensure that patients have access to the cognitive services needed to remain healthy and to ensure that all acute and chronic conditions are thoughtfully and effectively managed. Its members believe that CMS must ensure that cognitive services are properly defined and appropriately valued with respect to surgical procedures and other interventions.

The Alliance will work on the Resource Based Relative Value Scale (RBRVS) used by Medicare and all other insurance payers to value physician services in relation to one another must be revised to reflect the intensity of current cognitive care. The Alliance believes this must be done based on the collection of data by a nationally representative survey that is funded from existing federal resources. With this knowledge, the RBRVS can be modified to reflect the complexities of purely cognitive services.