In Setting Doctors’ Medicare Fees, CMS Almost Always Accepts The Relative Value Update Panel’s Advice On Work Values

Abstract

To calculate physicians' fees under Medicare-which in turn influence the physician fee schedules of other public and private payers-one of the essential decisions the Centers for Medicare and Medicaid Services (CMS) must make is how much physician time and effort, or work, is associated with various physician services. To make this determination, CMS relies on the recommendations of an advisory committee representing national physician organizations. Some experts on primary care who are concerned about the income gap between primary and specialty care providers have blamed the committee for increasing that gap. Our analysis of CMS's decisions on updating work values between 1994 and 2010 found that CMS agreed with 87.4 percent of the committee's recommendations, although CMS reduced recommended work values for a limited number of radiology and medical specialty services. If policy makers or physicians want to change the update process but keep the Medicare fee schedule in its current form, CMS's capacity to review changes in relative value units could be strengthened through long-term investment in the agency's ability to undertake research and analysis of issues such as how the effort and time associated with different physician services is determined, and which specialties-if any-receive higher payments than others as a result.

Improving the Quality and Lowering the Cost of Health Care: Medicare Reforms from the National Commission on Physician Payment Reform

“…A body such as the RUC should make an effort to be transparent since CMS has historically adopted more than 90 % of its recommendations. 5 Notwithstanding, the RUC has made positive strides in recent years. In 2012, the AMA added new primary care and geriatrics seats to the RUC and now requires that all vote totals be made publically available.…”

Pitfalls of Revising Physicians’ Relative Value Units (RVUs) in Iran: A Qualitative Study on Medical Practitioners’ Perspective

“…An inductive content analysis based on the Elo and colleagues' approach (14), included the 3 consecutive phases below:…”

“…This can make an atmosphere of trust among most stakeholders. The Center for Medicare and Medicaid (CMS) makes such an atmosphere through the updating committee that receives comments from different parties and make them post it after drafting a new version (14). The SHIC should have obligated the technical aspects of valuing health services to multidisciplinary teams with more active contribution of medical associations/societies.…”

“…The SHIC should have obligated the technical aspects of valuing health services to multidisciplinary teams with more active contribution of medical associations/societies. The CMS agreed about 87% of changes offered by the committee and they emphasized on the importance of capacity building by CMS for strengthening of its abilities in analyzing the technical aspects of valuing the health services (14). Defining a logical process for adjusting the physicians' fees has been highlighted by Ginsburg et al (9).…”

Fee-For-Service Will Remain A Feature Of Major Payment Reforms, Requiring More Changes In Medicare Physician Payment

“…12 The committee is managed by the American Medical Association and composed of members representing specialty societies. The effort to include numerous specialties in the process has led to a very small presence of primary care physicians on the committee.…”