AMA's Role in Setting Medicare Fees Battered

Margaret Dick Tocknell, for HealthLeaders Media , July 24, 2013

Typically the RUC has been free to go about its business, but in recent years it has found itself under something of a microscope as the Medicare program struggles with increased healthcare costs, and McDermott and others question the CMS reliance on the RUC.

In separate reports this month, both the Washington Post and the Washington Monthly, took a good look at the internal workings of RUC. The committee is set up to advise CMS, but in reality, CMS "has accepted about 90%" of the RUC recommendations. The Washington Monthly article states that the RUC has "de facto control" over how about $85 million in Medicare funding is spent each year.

Its influence stretches beyond Medicare and extends to commercial payers. According to a 2009 document from the AMA practice management center, "more than 75% of private payers" incorporate Medicare's Relative-Value Scale fee schedule into at least one product line.

The Washington Post offered an example of a Florida physician who performs in a typical 9-10-hour-day at least 12 colonoscopies and four other procedures. According to the RUC a basic colonoscopy takes 75 minutes of physician time. Based on medical journals, interviews, and physician records, however, the typical colonoscopy takes closer to 30 minutes, according to the newspaper.

Barbara Levy, MD, the RUC chair, and the AMA are contesting some of the newspaper findings, too. She describes the colonoscopy findings as "based on outlier ambulatory surgical centers in Florida and some practices in Pennsylvania."

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1 comments on "AMA's Role in Setting Medicare Fees Battered"

David Harlow (7/25/2013 at 11:42 AM)
That's $85 Billion with a B. - And that's for Medicare physician reimbursement alone. The related costs (facility fees, including devices) are much higher. It is important to understand that even with a move away from fee-for-service medicine, there still needs to be agreement on how to budget for physician and other health care provider services. As this story demonstrates, there is some significant discontentment with the way in which the RUC dominates this issue on the physician side.




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