AMA's Role in Setting Medicare Fees Battered

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

Rep. McDermott, the ranking member of the House Ways & Means Subcommittee on Health, wants CMS to more or less stop rubber-stamping RUC decisions. His bill calls for CMS to have more "muscle and resources to do the job."  

Based on a recommendation from the nonpartisan Medicare Payment Advisory Committee, the bill would establish a panel of independent experts within CMS to review the work of the RUC, identify problems with the fee schedule, and develop evidence to justify more accurate updates. To avoid potential conflicts of interest, the panel would not have any direct interest in the fee schedule and would include Medicare beneficiaries.

The bill would require the panel to hold open meetings and publish minutes.

The current bill has already lined up the support of the American Academy of Family Physicians, which represents more than 110,600 family physicians, family medicine residents, and medical students. McDermott contends that the RUC has contributed to the primary care physician shortage by making specialties and subspecialties more financially lucrative.

Of course, the powerful AMA can be expected to flex its muscles and campaign purse strings. Rep. McDermott introduced a similar bill in 2011. It never saw the light of day after being assigned to two House committees: Energy & Commerce and Ways & Means.

Margaret Dick Tocknell is a reporter/editor with HealthLeaders Media.
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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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