The AANEM Board recently approved a new position statement, Electrodiagnostic Services: Pay for Quality
. This paper recommends that payers offer value based (VB) payment models for electrodiagnostic (EDX) services to provide quality patient care, ensure timely treatment, and reduce health care costs. The AANEM Board strongly believes that to provide quality EDX services and reduce the expense of health care, payers should ensure the providers are trained appropriately to perform EDX services.
The AANEM has voiced this position in previous position statements, including Who is Qualified to Practice Electrodiagnostic Medicine?
, Model Policy for Needle Electromyography and Nerve Conduction Studies
, and Recommended Policy for Electrodiagnostic Medicine
“This new position statement goes the next step and addresses the growing trend of tying payment to quality service. It’s designed to help everyone, private practice physicians and academic physicians, start a conversation with their carriers about paying for quality,” stated President-Elect Vince Tranchitella, MD. “I have had some success talking to my payers and encourage others to do the same.”
The 2013 cuts for EDX services by the Center for Medicare and Medicaid Services (CMS) resulted in a 32-67% reduction in reimbursement. Many private payers matched Medicare rates, resulting in even greater reductions for physicians who had been paid better than Medicare rates.
In September 2013 the AANEM conducted a member survey requesting information about 2012 payment rates from private insurance carriers. The results showed a wide discrepancy in rates. Seventy-two percent of practices were paid “up to 25% more” to “250% or more” than Medicare, while only 28% were paid below Medicare rates. This variance occurred in private practice and academic settings and across regions of the country. Hospital-based practices were most likely to be paid significantly above Medicare rates, with nearly 15% getting paid “126-150% above” Medicare and about 70% getting paid “up to 25% to 75% more” than Medicare.
The Electrodiagnostic Services: Pay for Quality
paper contains a sample VB payment table utilizing the survey data.* “We understand carriers need to cut costs and have not set the value based payments to return to 2012 rates. Our intent is to get providers closer to that amount in recognition of providing quality care,” stated Shirlyn A. Adkins, JD, executive director.
“We will use our state liaison program to educate payers that a value based incentive should only be paid for the indications listed in the position paper’s table. If the indication does not match, we will advocate that the carrier question the billing and pay, at most, the Medicare rate,” said Kathleen Micheletti, director of government relations.
The new position statement can be found at www.aanem.org/Practice/Position-Statements.aspx
*The table is provided for informational purposes for payers and physicians. It is not intended to suggest the rate that should be paid in any particular case and is not meant as the only solution to creating a VB system.