Lawmaker wants HHS to take closer look at doctor pay

By Meghan McCarthy

March 29, 2011

Rep. Jim McDermott, D-Wash., has joined the ranks of members who want to change the health care law, but unlike the others, he isn't trying to relax any of the statute's provisions. Instead, he wants to require the federal government to give Medicare doctors' reimbursement rates a closer look.

McDermott is slated to introduce legislation this week that would strengthen Section 3134 of the law, which requires the Health and Human Services secretary to "periodically" review specific Medicare reimbursements for certain procedures. McDermott wants to make that an annual process for HHS, and require the agency to use its own data to determine how much doctors should be paid.

As of now, a board of physicians organized by the American Medical Association holds closed-door meetings every five years to make recommendations to the Centers for Medicare and Medicaid Services on how much Medicare should pay for certain procedures. CMS adopts nearly 90 percent of recommendations made by the group, known as the Relative Value Scale Update Committee, or more commonly, RUC.

The group has faced criticism that some doctors have a keen interest in updating codes for treatments that are underpaid, but little incentive to overhaul -- and ultimately reduce -- payments for care where the cost has dropped thanks to technological advances. The independent board that advises Congress on Medicare payments, MedPAC, has called for CMS to strengthen its expertise in physician payments since 2006.

The AMA is sure to oppose the legislation. On Monday, RUC Chairwoman Barbara Levy wrote in Kaiser Health News that the RUC has "has stepped up its efforts to address any misevaluation" of certain treatments.

But some doctors' groups are already on board. The American Academy of Family Physicians and the Society of General Internal Medicine are backing the legislation. No surprise there, as primary doctors have long contended that their services lose out in the RUC process when compared to specialty physicians.


By Meghan McCarthy

March 29, 2011

http://www.govexec.com/oversight/2011/03/lawmaker-wants-hhs-to-take-closer-look-at-doctor-pay/33633/