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AMA News Room

July 22, 2013

FACT SHEET: Response to the Washington Post's "How a secretive panel uses data that distorts doctors' pay"

For immediate release:
July 22, 2013

The article and video published by the Washington Post distorts the AMA/Specialty Society RVS Update Committee (RUC)’s role in providing resource cost information to the Centers for Medicare and Medicaid Services (CMS). The AMA, and RUC Chair Barbara S. Levy, MD, provided the reporter with clarification and supporting data, much of which was ignored in the final publication.

  • The authors allege that relative values have primarily increased since 2003 leading to an increase in Medicare spending. This is FALSE. The work values for office and hospital visits increased in 2007 based on the Committee’s recommendations and then again in 2010 to account for budget neutrality when CMS eliminated payment for consultations. As surgeons are paid for their hospital care and follow up visits within a bundled package, all surgery CPT codes were increased to account for these visit increases. These adjustments, and all other increases to work values, are offset by reductions to the conversion factor. The assertion by the reporter that Congress overrode those reductions is inaccurate. The reporter was provided with a written published history of these conversion factor reductions. The reporter failed to note the difference between relative value budget neutrality and the SGR update. Physicians are subject to budget neutrality rules which require offsetting reductions when values are increased.
  • The Committee has worked vigorously over the past several years to identify and address misvaluations in the RBRVS through provision of revised physician time data and resources cost recommendations to CMS. The Committee fully acknowledges that there are services that are now performed more efficiently and these codes have been or will be addressed. For example, the time and valuation for cataract surgery was significantly reduced in 2013. Valuations associated with more than 500 physician services have been recently decreased, redistributing $2.5 billion to primary care and other physician services.
  • More than 100 gastrointestinal endoscopy services are currently under review by the Committee, including colonoscopy. The reporter was informed that the Committee was reviewing colonoscopy in April 2014 and the review of time will be an important factor in their analysis. However, the article includes colonoscopy as the case study and asserts, based on outlier ambulatory surgical centers in Florida and some practices in Pennsylvania, that gastroenterologists are typically performing in excess of 16 endoscopies per day. The AMA requested to review the data and analysis and it was not provided. The AMA provided the reporter with data that the average number of cases per gastroenterologists per year is 1,482 (MGMA, 2010) and the average gastroenterologist works 46.7 weeks per year (AMA PPI Survey, 2006), leading to an average of 6-8 endoscopies per day.
  • The ophthalmology procedures referenced within the article appear to include LASIK surgeries, as well as cataract surgeries. The reporter was informed that these data are irrelevant to Medicare expenditures since LASIK surgery is not covered by Medicare. However, it appears that these data were utilized in the “analysis” conducted by the newspaper.
  • The Committee is not a secretive body. Transparency is important to the Committee, and they have implemented processes to improve transparency. However, the Committee is not a political process and has no intent to influence markets or private payors. The Committee’s recommendations are intended to provide clinical expertise to CMS to utilize as one source of data in developing relative values. The reporter was invited to attend a meeting. More than 300 individuals attend each meeting, and CMS representatives are present for all deliberations. In fact Thomas Scully, interviewed for both the article and video, attended a Committee meeting when he was Administrator of CMS. The reporter was provided with minutes of this meeting, where Mr. Scully praised the Committee for its work and conducted an open door conference call for hundreds of physician practices from the meeting.

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