Physician group pressures CMS to demand changes in pay panel

Looks like CMS had already been getting pressure to revamp the system that relies on a secret panel of doctors to help set the values of codes in the Medicare physician fee schedule. In a letter dated Oct. 8, Dr. Lori Helm, the board chair of the American Academy of Family Physicians, called on CMS Administrator Dr. Donald Berwick to consider creating alternatives to the American Medical Association's secret panel, or Relative Value Scale Update Committee.

AAFP, which is one of the member organizations represented in the Relative Value Scale Update Committee (RUC), echoed the Medicare Payment Advisory Commission's 2006 recommendation that CMS establish a group of experts that is separate from the AMA RUC to help the agency review and validate relative value units (RVU).

The letter notes that "the review process would benefit if CMS had an additional means of identifying misvalued services and validating RVUs and if supporting evidence was collected and analyzed not only by medical specialty societies but also by experts who were less invested financially in the outcome." According to MedPAC, the current process, which relies on physician specialty societies to identify services for review, tends to identify and correct undervalued services, but is not good at identifying services that may be overvalued.

Helm also asked for a fundamental change in the composition of the RUC to more equitably recognize the value of primary care. Primary care, which AAFP defines as family medicine, general internal medicine, and general pediatrics, has at most five seats on the 29-person panel, assuming that the American College of Physicians, American Academy of Pediatrics, American Osteopathic Association, and American Medical Association all appoint primary care physicians, and not subspecialists to represent them, she writes.

To learn more:
- read the American Academy of Family Physicians letter to CMS

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