ACOG Successful in Efforts to Increase Value of Maternity Services
Two years after a comprehensive review of the value of physician work for maternity services, CMS accepted most recommendations made by the RBRVS Update Committee (RUC), resulting in 2012 increases of up to 17% over the previous values.
The RUC traditionally uses a survey to help determine the correct relative value of services, but the maternity codes had never previously been surveyed because of the unusual nature of the global ob codes. CMS asked that ACOG, with the American Academy of Family Physicians (AAFP), develop a special survey instrument and develop value recommendations. Recommendations were presented at the October 2009 RUC meeting. The RUC rarely accepts the values recommended by specialty societies. However, the final RUC recommendations to CMS that came out of that meeting were significantly higher than the values that had been previously assigned.
The RUC recommendations were delivered too late in 2009 to be included in the 2010 physician fee schedule. When CMS published the final 2011 fee schedule, ACOG was surprised and dismayed that CMS had applied a .8922 multiplier to the values, effectively eliminating the increases that were recommended by the RUC. ACOG and the AAFP immediately went to work to get CMS to reverse that decision.
Letters were written to the CMS Administrator. ACOG and the AAFP had a face-to-face meeting with CMS staff, and ACOG had a follow-up teleconference to further explain the rationale for the increased values. In November 2011, more than two years after ACOG had surveyed and first presented the codes, CMS published the fee schedule that showed they had finally accepted nearly all of the RUC recommendations.
Special thanks to ACOG physicians Sandra Reed, George Hill, and Gregory DeMeo, and to AAFP physician Tom Weida for all of their hard work on this effort.
Maternity Code Physician Work Values from 2010 to 2012
||Routine obstetric care including antepartum care, vaginal delivery (with or without episiotomy, and/or forceps) and postpartum care
||Vaginal delivery only (with or without episiotomy and/or forceps);
||Vaginal delivery only (with or without episiotomy and/or forceps); including postpartum care
||External cephalic version, with or without tocolysis
||Delivery of placenta
||Antepartum care only; 4-6 visits
||Antepartum care only; 7 or more visits
||Postpartum care only
||Routine obstetric care including antepartum care, cesarean delivery, and postpartum care
||Cesarean delivery only;
||Cesarean delivery only; including postpartum care
||Routine obstetric care including antepartum care, vaginal delivery (with or without episiotomy, and/or forceps) and postpartum care, after previous cesarean delivery
||Vaginal delivery only, after previous cesarean delivery (with or without episiotomy and/or forceps);
||Vaginal delivery only, after previous cesarean delivery (with or without episiotomy and/or forceps); including postpartum care
||Routine obstetric care including antepartum care, cesarean delivery, and postpartum care, following attempted vaginal delivery after previous cesarean delivery
||Cesarean delivery only, following attempted vaginal delivery after previous cesarean delivery;
||Cesarean delivery only, following attempted vaginal delivery after previous cesarean delivery; including postpartum care