When you estimate prices for services that involve thousands of services, getting it right can be difficult. The AMA has worked hard to ensure the accuracy of time to conduct a procedure but as you can imagine much of the time spent on a procedure varies greatly from doctor to doctor.
H.R. 2545, introduced in the House by Rep. Jim McDermott, M.D., D-Wash, is designed to supplement the work of the AMA/Specialty Society Relative Value Scale Update Committee (RUC) by establishing an expert panel within Medicare to oversee the valuation of physician services and to help correct distortions in the physician fee schedule. The text of the bill can be found here, and more information about the legislation.
As noted by Rep. McDermott's office: "Currently, the RUC, a committee of 31 physicians empaneled by the American Medical Association (AMA), conducts reviews in closed meetings and provides limited release of the minutes of its proceedings. It is unevenly weighted by procedural specialists over primary care doctors and relies heavily on anecdotal and self-serving survey evidence, rather than forensic data. This causes skewed fees for procedure-based services such as pathology, surgery and imaging, eroding pay to primary care physicians."
"No other area of the Medicare program asks providers to play such an active role in setting their own payments," said McDermott. "Medicare certainly needs clinical expertise in order to fairly set reimbursements, but an outside organization, whose members benefit from $70 billion in annual public spending, needs checks and balances. No matter how well-intentioned, structural biases are inevitable and we're seeing that effect as new doctors flock toward specialty care and away from primary care."
Based on a recommendation from the nonpartisan Medicare Payment Advisory Committee, McDermott's bill would establish a panel of independent experts within the Medicare agency to identify distortions in the fee schedule and develop evidence to justify more accurate updates. The panel would be composed of members without any direct conflicts of interest and would include patient representatives. It would also be subject to the Federal Advisory Committee Act, which requires advisory bodies to hold open meetings and publish minutes. Under the bill, Medicare could continue to request work from the RUC, but the independent experts would both initiate such requests and review RUC's work product.
The American Academy of Family Physicians (AAFP) supports the bill, and in a letter to McDermott, AAFP Board Chair Glen Stream, M.D., M.B.I., of Spokane, Wash., described the bill as "long overdue" and said that it "could make a major difference in how the Medicare payment system supports primary care physicians in offering better quality health care more efficiently."
Stream also said, however, that the legislation's expert valuation panel should include at least one primary care physician to provide a "perspective that has been most underrepresented in previous deliberations of the relative value of physician services."
Stream told McDermott, "We agree with your observation that CMS needs to have the expertise required to evaluate physician services and that this evaluation should be as objective and free as possible from the appearance of conflicts of interest. Your legislative proposal would go a long way toward providing CMS with the independent expertise that it needs, and it is consistent with prior recommendations of the Medicare Payment Advisory Commission and recommendations we made to the RUC last year."
"With the recent release of two mainstream exposes, one in the Washington Post and another in the Washington Monthly, the American Medical Association's (AMA) medical procedure valuation franchise, the Relative Value Scale Update Committee (RUC), has been exposed to the light of public scrutiny. 'Special Deal,' Haley Sweetland Edwards' piece in the Monthly, provides by far the more detailed and lucid explanation of the mechanics of the RUC's arrangement with the Centers for Medicare and Medicaid Services (CMS)."
"For its part, the Post contributed new information by calculating the difference between the time Medicare currently credits a physician for certain procedures and actual time spent. Many readers undoubtedly were shocked to learn that, while the RUC's time valuations are sometimes way off, in some cases physicians may be paid for more than 24 hours of procedures in a single day."
It is unlikely that given the current makeup of congress this bill has much room for success, but is does contribute to the debate to reform the physician payment system, which in the future with the right plan could muster bipartisan support.