Trump Administration Weighs Overhaul of Doctor Payments in Medicare

See link: https://www.medpagetoday.com/publichealthpolicy/medicare/122383

Some parts paraphrased below

"The request for information issued on July 14 by the Centers for Medicare & Medicaid Services (CMS) noted that the Current Procedural Terminology (CPT) coding system, on which the Medicare reimbursement program is based, is owned by the American Medical Association (AMA). The AMA assigns a CPT code to each service and procedure and then collects its own data to develop recommendations for CMS on how much each CPT code should be worth. "There has ... been longstanding concern expressed over the federal reliance on a private organization with such an obvious conflict of interest as providing information on the time and resource requirements to conduct physician services when this information may influence their own payment," the authors of the request stated.

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"This issue is part of a broader conversation about the way different types of care are valued under Medicare's current payment system," he wrote. "Primary care physicians tend to be paid less overall than specialty physicians under Medicare, and some of that has to do with the fact that medical procedures (such as surgeries or tests) are easier to code and bill for under this type of coding system, compared to things like patient education or care coordination that make up a larger share of primary care work."

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David Glaser, an attorney with the Fredrikson & Byron law firm in Minneapolis, said the idea of possibly getting rid of CPT codes "is a major thing," and not necessarily a good idea. "When you have a system, even when it's flawed and everyone agreed it's flawed, that doesn't mean change is a good thing," he said in a phone interview.

"Love it or hate it, CPT is very ingrained in our system," he said. And although you could always come up with a better system, "does that make it wise to come up with a new system here? It seems to me like it would be quite an earth-shattering thing to start again."

But whether the CPT coding system is retained or not, Baker liked another idea: cutting out the AMA's RVS Update Committee (RUC), the committee that recommends changes in or additions to the relative value units used in the RVS. "[With] the RUC maligned for numerous reasons, CMS should rely less heavily (or not at all) on the committee's input," he said. "CMS already must validate the [RUC's] recommendations, so removing the RUC from the process can create a more responsive payment environment without additional, duplicative inputs."

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Michael Baker, director of healthcare policy at the American Action Forum, a right-leaning think tank, said he liked the idea of considering a move from CPT to ICD-10. "Because of how ICD-10 is structured, this could move the entire Medicare payment system toward a patient-centric view rather than a provider-centric view," he told MedPage Today in an email.

But whether the CPT coding system is retained or not, Baker liked another idea: cutting out the AMA's RVS Update Committee (RUC), the committee that recommends changes in or additions to the relative value units used in the RVS. "[With] the RUC maligned for numerous reasons, CMS should rely less heavily (or not at all) on the committee's input," he said. "CMS already must validate the [RUC's] recommendations, so removing the RUC from the process can create a more responsive payment environment without additional, duplicative inputs."

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CMS is not the only place on Capitol Hill where there is interest in possibly moving away from use of CPT codes. Last October, Sen. Bill Cassidy, MD, (R-La.) sent the AMA a letter seeking an explanation of how CPT codes are generated, whose input is incorporated in developing them, and how much revenue the publication and licensing of these codes provides.

"I am particularly offended by the AMA abusing its government-endorsed CPT monopoly to charge every stakeholder in the healthcare system significant amounts of money while advancing an anti-patient agenda," wrote Cassidy, who is chairman of the Senate Health, Education, Labor, and Pensions Committee."

Commentary: So even though they are reevaluating possibly trying to compensate PCPs more for their work compared to specialists--would say yay for me, an FM, but I don't trust these people to tie their shoes without slicing everyone’s hamstring--it looks like they are essentially seeking to railroad doctors completely out of having any input on income at all.

They mention monopoly regarding the RUC repeatedly. Ignoring the multiple deliberate monopolies in the US training pipeline and healthcare in general. As we say passive aggressively in the midwest: "That's interesting..."

PS: To every specialist for voted for this: enjoy whats coming to you.

Author: EmotionalEmetic