{"id":53,"date":"2014-08-27T16:55:16","date_gmt":"2014-08-27T16:55:16","guid":{"rendered":"http:\/\/healthcare.davidstates.net\/?p=53"},"modified":"2014-08-27T16:55:16","modified_gmt":"2014-08-27T16:55:16","slug":"how-physicians-get-paid-the-arcane-differences-matter","status":"publish","type":"post","link":"https:\/\/healthcare.davidstates.net\/?p=53","title":{"rendered":"How Physicians Get Paid, the Arcane Differences Matter"},"content":{"rendered":"

Nice article by Katie Jennings in Politico\u00a0http:\/\/www.politico.com\/magazine\/story\/2014\/08\/health-care-costs-110184.html<\/span><\/a><\/span><\/p>\n

Physician compensation depends critically on the Relative Value Unit (RVU) scale set by the\u00a0the AMA\/Specialty Society Relative Value Scale Update Committee\u00a0(RUC).<\/p>\n

http:\/\/www.ama-assn.org\/ama\/pub\/physician-resources\/solutions-managing-your-practice\/coding-billing-insurance\/medicare\/the-resource-based-relative-value-scale\/the-rvs-update-committee.page<\/a><\/span><\/p>\n

http:\/\/www.kaiserhealthnews.org\/stories\/2010\/october\/27\/ama-center-public-integrity.aspx<\/a><\/span><\/p>\n

This area bears continued scrutiny. \u00a0It may seem arcane, but we are talking about half a trillion dollars of public expenditure.<\/p>\n

1) There is a chronic undersupply of primary care docs and chronic oversupply of specialists. \u00a0Does not this indicate that we are systematically underpaying PCPs and over paying specialists? \u00a0Are not there economic models for what prices should be? \u00a0How badly skewed are the AMA RVU values?<\/p>\n

2) Why does CMS continue to accept this system? \u00a0Any way to estimate how much biases in the RVU scale are costing Medicare?<\/p>\n

3) Congress has specified the use of these codes by law and prohibited judicial review of the RVU system. \u00a0Is the committee de facto<\/em> performing a government function and therefore subject to open government regulations? \u00a0Are committee documents subject to the Freedom of Information Act?<\/p>\n

3) Who are the members of the AMA Committee? \u00a0Do they file conflict of interest disclosures? \u00a0What conflicts have been disclosed? \u00a0Aside from the final list of CPT codes and RVUs, does the committee keep and publish minutes, notes or other material?<\/p>\n

4) The composition of the RUC (see AMA page) is heavily biased towards specialists with only 3 members from primacy care areas (internal medicine, family practice and primary care) but 30% of all physicians are in primary care and more are needed. \u00a0The AMA sites states that composition reflects Medicare expenditures but should it not instead reflect Medicare needs? \u00a0Does CMS have any input into the composition or membership of the committee?<\/p>\n

5) Is the AMA copyright on CPT codes enforceable? \u00a0The final physician fee schedule is the result of a federal rule making process and is published in the Federal Register. \u00a0Does not this make the fee schedule including codes and definitions the result of government work and therefore uncopyrightable? \u00a0If the copyright on CPT codes and their definitions is enforceable, is CMS giving away public property by incorporating copyright codes and definitions into their reimbursement scale? \u00a0The AMA apparently makes a considerable amount of money licensing this material. \u00a0Anyone know how much? \u00a0The CMS website specifically prohibits public disclosure of CPT codes and which inhibits public discussion of reimbursement practices. \u00a0Does this violate the First Amendment? \u00a0For the purposes of promoting public discussion of RVUs, someone might want to publish the list of codes and definitions on a public website, but to do this they would have to license the material from the AMA.<\/p>\n

http:\/\/www.cms.gov\/medicare-coverage-database\/license\/cpt-license.aspx<\/a><\/span><\/p>\n","protected":false},"excerpt":{"rendered":"

Nice article by Katie Jennings in Politico\u00a0http:\/\/www.politico.com\/magazine\/story\/2014\/08\/health-care-costs-110184.html Physician compensation depends critically on the Relative Value Unit (RVU) scale set by the\u00a0the AMA\/Specialty Society Relative Value Scale Update Committee\u00a0(RUC). http:\/\/www.ama-assn.org\/ama\/pub\/physician-resources\/solutions-managing-your-practice\/coding-billing-insurance\/medicare\/the-resource-based-relative-value-scale\/the-rvs-update-committee.page http:\/\/www.kaiserhealthnews.org\/stories\/2010\/october\/27\/ama-center-public-integrity.aspx This area bears continued scrutiny. \u00a0It may seem arcane, but we are talking about half a trillion dollars of public expenditure. 1) There is a … Continue reading How Physicians Get Paid, the Arcane Differences Matter<\/span> →<\/span><\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[],"class_list":["post-53","post","type-post","status-publish","format-standard","hentry","category-uncategorized"],"_links":{"self":[{"href":"https:\/\/healthcare.davidstates.net\/index.php?rest_route=\/wp\/v2\/posts\/53","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/healthcare.davidstates.net\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/healthcare.davidstates.net\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/healthcare.davidstates.net\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/healthcare.davidstates.net\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=53"}],"version-history":[{"count":3,"href":"https:\/\/healthcare.davidstates.net\/index.php?rest_route=\/wp\/v2\/posts\/53\/revisions"}],"predecessor-version":[{"id":56,"href":"https:\/\/healthcare.davidstates.net\/index.php?rest_route=\/wp\/v2\/posts\/53\/revisions\/56"}],"wp:attachment":[{"href":"https:\/\/healthcare.davidstates.net\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=53"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/healthcare.davidstates.net\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=53"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/healthcare.davidstates.net\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=53"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}