AMA assails proposed Medicare physician payment cuts as ‘arbitrary’

August 13, 2013

In its summary of key provisions, the American Medical Association (AMA) harshly criticized several components of the proposed 2014 Medicare Physician Fee Schedule.

 

In its summary of key provisions, the American Medical Association (AMA) harshly criticized several components of the proposed 2014 Medicare Physician Fee Schedule.

As part of its proposed rule released in July, the Centers for Medicare and Medicaid Services (CMS) is calling for large payment reductions for more than 200 services, which it claims are misvalued because physician offices receive larger reimbursements than ambulatory surgical centers or outpatient departments at hospitals would receive for the same services. The 2014 proposal would cap physician payments for those services at the same amount the hospitals receive.

The AMA calls this policy “arbitrary” and defends the higher payment for services in physician offices. Using CPT code 88367 as an example, the AMA says this rule would cut that reimbursement to physicians by 79%.

“For hospitals, payments above and below the cost of service are assumed to average out over time,” the summary says. “But physicians…cannot offset their losses this way. The AMA will aggressively oppose this proposal and seek to delay implementation until the RUC can review these codes.”

The summary also addresses the AMA’s Specialty Society Relative Value Scale Update Committee (RUC), which recently has faced scrutiny after an article critical of its neutrality appeared in The Washington Post in July. The AMA stated that through objective screens and cross-specialty review, the RUC successfully identified incorrectly-valued services that resulted in $2.5 billion in redistribution within the Medicare Physician Payment Schedule.

The AMA also expressed concern over several other CMS provisions including:

  • The Value-Based Payment Modifier, which AMA argues cannot be applied equitably

  • Liability for Overpayments, which Congress has extended to 5 years

  • Physician Compare website, which the AMA says CMS is expanding without ensuring the accuracy of information

 

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