To inform its decisions, the committee relies on surveys submitted by the relevant professional societies. For example, in setting the value for a colonoscopy, the committee has turned to the American Gastroenterological Association and a similar group for information. Typically, the surveys ask doctors about the time and intensity of the procedure under study. The survey to you and other the standard form tells doctors, “is important physicians,” “because these values determine the rate at which Medicare and other payers reimburse.” Sometimes the doctors within a specialty will overestimate the value of their work, Levy said. When that happens, the committee has increasingly decided to significantly lower their estimates of the work involved. a cardiologist, and I think I am the most important thing on Levy said. “Suppose I am Earth,” The RUC, she said, may have to say, important “We know you’re really but” you’ve overestimated the work involved on the survey. 31 voting people around that table can be really Levy said. can come to “The harsh,” “Someone us with data that looks skewed, and we tell them, pass the ‘It doesn’t smell test.’ ” But critics of the AMA process, including former Medicare chiefs and the Harvard researchers who created the system, say that biased surveys and other conflicts of interest make the results unreliable. In developing the point system, the Harvard researchers and the government made available their raw data and statistical methods and held public meetings; they also limited the role of the AMA and specialist societies, participants in that process said. The AMA process is not so open. The current set of values to be said William Hsiao, an economist at the “seems distorted,” Harvard School of Public Health who helped develop the point system. AMA fought very “The hard to take over this updating process. I said this had to be done by an impartial group of people. This is highly political.” **** Federal law makes the importance of time explicit: The work points assigned to a procedure will reflect the time and intensity in furnishing the and includes the “physician service” physician’s time before, during and after a procedure. Every year, the Medicare system publishes its which are based on AMA surveys. the accuracy of procedure time assumptions used in physician fee schedule “Improving ratesetting continues to be a high agency officials time is a priority,” wrote last year. “Procedure critical measure.”
To inform its decisions, the committee relies on surveys submitted by the relevant professional societies. For example, in setting the value for a colonoscopy, the committee has turned to the American Gastroenterological Association and a similar group for information. Typically, the surveys ask doctors about the time and intensity of the procedure under study. The survey “is important to you and other physicians,” the standard form tells doctors, “because these values determine the rate at which Medicare and other payers reimburse.” Sometimes the doctors within a specialty will overestimate the value of their work, Levy said. When that happens, the committee has increasingly decided to significantly lower their estimates of the work involved. “Suppose I am a cardiologist, and I think I am the most important thing on Earth,” Levy said. The RUC, she said, may have to say, “We know you’re really important but” you’ve overestimated the work involved on the survey. “The 31 voting people around that table can be really harsh,” Levy said. “Someone can come to us with data that looks skewed, and we tell them, ‘It doesn’t pass the smell test.’ ” But critics of the AMA process, including former Medicare chiefs and the Harvard researchers who created the system, say that biased surveys and other conflicts of interest make the results unreliable. In developing the point system, the Harvard researchers and the government made available their raw data and statistical methods and held public meetings; they also limited the role of the AMA and specialist societies, participants in that process said. The AMA process is not so open. The current set of values “seems to be distorted,” said William Hsiao, an economist at the Harvard School of Public Health who helped develop the point system. “The AMA fought very hard to take over this updating process. I said this had to be done by an impartial group of people. This is highly political.” **** Federal law makes the importance of time explicit: The work points assigned to a procedure will reflect the “physician time and intensity in furnishing the service” and includes the physician’s time before, during and after a procedure. Every year, the Medicare system publishes its which are based on AMA surveys. “Improving the accuracy of procedure time assumptions used in physician fee schedule ratesetting continues to be a high priority,” agency officials wrote last year. “Procedure time is a critical measure.”
20130728_how_a_secretive_panel.docx