The 2019 Medicare Physician Fee Schedule was released Nov. 1, 2018, with generally good news for emergency medicine. As anticipated, there were minimal changes to the emergency department evaluation and management (E/M) codes, critical care, and observation service values for 2019. Table 94 of the Final Rule lists the estimated impact by specialty based on changes to the work, practice expense, and professional liability insurance relative value units (RVUs) for 2019. Many of the specialties listed, including emergency medicine, had an estimated change of 0 percent in overall revenue. There were few winners, such as podiatry with a 2 percent increase. The losers in 2019 are extensive, including diagnostic testing facilities with a 5 percent decrease, as well as independent laboratory, pathology, nuclear medicine, optometry, and infectious disease with 1 percent decreases. Many of the specialties receiving decreases have had their revenues go down several years in a row, while emergency medicine has been stable or slightly up.

Emergency Medicine RVUs Stable

The 2018 Physician Final Rule highlighted concerns that emergency department E/M services may be undervalued. As a result, ACEP undertook a vigorous survey process related to the emergency department E/M codes (99281–99285) that make up 83 percent of our RVUs. The survey results were robust and presented for valuation by the Relative Value Scale Update Committee (RUC). Although the RUC’s deliberations remain confidential, we are able to share that the ACEP RUC advisers presented compelling arguments demonstrating the increase in the acuity of our patients, and the Centers for Medicare & Medicaid Services (CMS) will consider the RUC’s recommendations as part of the 2020 Medicare Physician Fee Schedule (see “What’s in the 2019 Medicare Physician Fee Schedule Proposed Rule?” September 2018). The updated RVUs, based on the recent survey and presentation, will likely be published for use in 2020. For 2019, in the interim, the emergency department RVUs for 99281–99285 remain exactly the same as last year (see Table 1). Only critical care will change for 2019 with a very small decrease at the hundredth of an RVU level.

(click for larger image) Table 1: 2018 and 2019 Emergency Medicine RVUs
RVU=relative value unit; PE=practice expense; PLI=professional liability insurance

Conversion Factor (Medicare Payment Per RVU) Increases

The Bipartisan Budget Act of 2018 mandated a 0.25 percent increase to the conversion factor for 2019. A negative budget adjustment factor of –0.14 percent impacted the 2019 conversion factor to offset overall increases in RVUs relative to 2018. The net impact is an increase of about $0.04 to the 2019 conversion factor, as shown in Table 92 from the Final Rule, with a published conversion factor of $36.0391 (see Table 2).