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How Medicare changes physician reimbursement

The Wall Street Journal has an excellent report on the key step in determining Medicare physician reimbursement.
Here’s the intro:
“Three times a year, 29 doctors gather around a table in a hotel meeting room. Their job is an unusual one: divvying up billions of Medicare dollars.
The group, convened by the American Medical Association, has no official government standing. Members are mostly selected by medical-specialty trade groups. Anyone who attends its meetings must sign a confidentiality agreement.
Yet the influence of the secretive panel, known as the Relative Value Scale Update Committee, is enormous. The Centers for Medicare and Medicaid Services, which oversee Medicare, typically follow at least 90% of its recommendations[emphasis added] in figuring out how much to pay doctors for their work. Medicare spends over $60 billion a year on doctors and other practitioners. Many private insurers and Medicaid programs also use the federal system in creating their own fee schedules.”
The link probably expires tomorrow, so read it now, or print and read it on a plane later.
thanks to Advisen for the tip.

One thought on “How Medicare changes physician reimbursement”

  1. RUC and CMS have a strange way of compounding payment problems through “unintended consequences” of their decisions. For example CMS decided recently to so drastically reduce reimbursement for Nuc. Med stress testing performed in an outpatient office that the provider could not afford to perform the exam. These tests are now performed in the hospital in our community at approximately 4 times the previous cost. It would also be nice if RUC would take a stand against the corrupting and costly aspects of imaging service self referral especially by Oncology and Orthopedic groups…but that would take more thoughtfullness than these folks appear capable of.

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Joe Paduda is the principal of Health Strategy Associates



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