Hey secret pay panel, why so mysterious?


Was anyone else surprised by this week's revelation in the Wall Street Journal about a secret physician panel that provides input to help define fees paid by Medicare?

The secret panel, known as the Relative Value Scale Update Committee (RUC), is composed of 29 members chosen by medical specialty trade groups, and seems to hold sway over how more than $60 billion in Medicare dollars are spent on doctors and other practitioners. The panel estimates how much work a physician must do to perform a specific task. CMS considers the panel's input when setting doctors' fees. The agency usually hews to at least 90 percent of the group's recommendations, despite the its lack of government standing.

If you're wondering why anyone should care, consider this: The panel's decisions affect more than just how much a physician will get for heart surgery or specific back procedures. When Medicare says something is worth more, doctors in our pay-for-service culture are motivated to do more of whatever it is, and there are related costs for hospitals, lab tests and drugs. As CMS Deputy Administrator Jonathan Blum put it, "Overvalued codes can lead to spending growth."

Dr. Barbara Levy, a Seattle area gynecologist and the group's chairwoman, told the WSJ that the panel is trying to correct evaluations that lead to payments that are too high for some services. "The RUC is not a perfect process, it's just the best that's out there," she said.

Apparently there's room for improvement. According to the Medicare Payment Advisory Commission, a Congressional watchdog organization, RUC recommended pay hikes for 1,050 services in the last three doctor payment reviews to correct payments that were not in line with reality. It endorsed cuts in 167.

No wonder health costs are spiraling out of control. While it makes sense to have physician experts on the panel, maybe some more filtering should occur so CMS doesn't accept so readily what the RUC comes up with--without first checking assumptions. A more transparent process might help mitigate costs too. Let's see who sits on the panel and how they vote. And what kind of data do they use as the basis of their assumptions?

Maybe the panel would be stronger if it also included people with no vested interest in physician payments. Let some sunshine stream into the hotel meeting room where the panel deliberates. Maybe these changes could make the decisions over what should be factored into payments for services more rational and less self serving. - Sandra

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