Medicare Physician Fee Schedule Transition Program

HSG 2021 Medicare Physician Fee Schedule Transition Program

MPFS Transition Program

Download HSG 2021 MPFS Transition Program Here

Approach Summary and Rationale

Many organizations are struggling to determine if and how to adjust provider compensation plans as a result of the recently released 2021 Medicare Physician Fee Schedule (MPFS) which introduces changes to E&M coding requirements and adjusts wRVU values for those services. With these changes going into effect on January 1^st, and with initial analyses suggesting up to 20% increases in total wRVUs per provider, organizations are scrambling to develop compensation strategies that preserve financial sustainability.

For these reasons, we recommend a MPFS Transition Program that allows for a structured approach to educating providers,  measuring potential impacts, and later phasing the 2021 MFPS changes into the actual provider compensation process.

A central component to this approach is continuing to utilize the 2020 MPFS wRVU values for the purposes of provider compensation. This allows time for the organization to educate providers and collect data in order to better plan for compensation changes that can be implemented when the organization updates to using the most current MPFS parameters.

We recommend this approach because we believe attempting to alter compensation plans prior to January 1^st is problematic for the following reasons:

• The final rule introduces significant changes that will impact distribution of E/M codes AND the wRVU values associated with those codes. Therefore, projecting a provider’s 2021 wRVU production using is complicated. It is not as simple as plugging in new values for each CPT code.
• This will make it difficult to adjust compensation models and/or rates in a way that is budget neutral to the provider and to the organization.
• Incorrect analysis may lead to negative consequences:
  • Provider relationship degradation if providers receive less compensation for similar effort and volume productivity; and/or
  • Financial upheaval caused by providers receiving significantly more compensation for similar productivity volume – which is potentially compounded by decreasing reimbursement.

HSG Support

HSG provides support during the MPFS Transition Program by:

1. Conducting a series of provider education sessions to familiarize the providers with the 2021 MPFS, provider tangible coding support, and prepare for potential impact to wRVUs and compensation rates
2. Performing initial and baseline analyses to help the organization project wRVU increases and adjust compensation rates accordingly

Program Cost

Comprehensive program as shown below will cost $24,500. Program can also be customized based on individual client needs. For example, the 2021 Medicare Physician Fee Schedule changes are promoting many organizations to use the transition period to substantially revise their provider compensation plans to incorporate non-productivity incentives. HSG can incorporate support for that process at additional cost.