Federal Regulator, Meet Dr. Regulated

Joe Cantlupe, for HealthLeaders Media , July 25, 2013

"The enormous, complex regulatory mechanism put in place in American medical care is increasingly resembling what medicine would be like if practiced by economists, not medicine as practiced by physician," says Hyde. "The truth is, however, that doctors will tell you that patient care is more complex than can be provided for "in guidelines."

What's happening now are the "unintended consequences" of regulations, Hyde writes.

Those regulations are certainly hindering patient care, at least in the eyes of physicians. But maybe more economists should be involved, at least when it comes to physician pay. That argument comes on the heels of the Washington Post report last Sunday that said physicians were paid, in some cases, based on hour-estimates and specialties recommended by the American Medical Association that were inflated. Federal regulators are essentially responsible for approving such payments, but are woefully understaffed to monitor the AMA bean counting.

The Post referred to the AMA/Specialty Society RVS Update Committee (RUC)'s role in providing "resource cost information" to the Centers for Medicare & Medicaid Services. Every three years, the committee meets for several weeks to review procedures and cost estimates. In a review of more than 5,000 procedures over a 10-year period, the Post uncovered a wide variation in payments, including instances in which physicians would have to put in more than 24 hours each day for procedures, such as colonoscopy, to get the pay the AMA recommends in its value-scale.

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