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    Expect federal scrutiny of RUC to intensify

    Release of CMS data could add momentum to reform efforts

    Bob GattyBob GattyWashingtonThe law signed April 1 that avoided the slated 24% Medicare physician payment cut for this year will intensify federal scrutiny of the current system for valuing specific medical services, a procedure that is at the heart of how much doctors get paid.

    The Protecting Access to Medicare Act of 2014 requires the Government Accountability Office (GAO) to study how the American Medical Association’s Relative Value Scale Update Committee (RUC) determines the time and intensity values of each procedure and how Medicare uses those values to decide how much it will pay.

    “This is absolutely a move in the right direction,” said Robert A. Berenson, MD, an institute fellow at the Urban Institute and former vice chair of the Medicare Payment Advisory Commission (MedPAC). The GAO study will “keep the pressure on the process,” he told The Washington Post on March 31.

    AUA opposes GAO study provision

    The AUA opposed the GAO study provision in the new law, arguing that “The vast majority of physician services have been reviewed, resurveyed, and revalued, over the course of the past few years.”

    The AUA said, “We (as well as our colleagues in the Alliance of Specialty Medicine) do not believe this provision is necessary and therefore urged its elimination,” adding that it would have a “disproportionate impact on specialty physicians.”

    The action by Congress followed publication of a detailed investigative study by The Washington Post in which it said “many procedures are exaggerated, sometimes by as much as 100%, according to an analysis of doctors’ time, as well as interviews and reviews of medical journals.” The Post’s July 20, 2013 report cited examples in which some gastroenterologists are reporting completing so many colonoscopies in 1 day that if the AMA’s assumptions about procedure times were correct, that much work would take more than 24 hours.

    “If AMA estimates of time are correct, hundreds of doctors are working improbable hours,” the Post reported. “In some specialties, more than one in five doctors would have to have been working more than 12 hours on average on a single day—much longer than the 10 hours or so a typical surgery center is open.”

    The article quoted Tom Scully, JD, administrator of the Centers for Medicare & Medicaid Services during the George W. Bush administration, as saying, “The idea that $100 billion in federal spending is based on fixed prices that go through an industry trade association in a process that is not open to the public is pretty wild.”

    Continue to next page for more.

    Bob Gatty
    Bob Gatty, a former congressional aide, covers news from Washington for Urology Times.

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