June 28, 2013 - Issue: Vol. 159, No. 95 — Daily Edition113th Congress (2013 - 2014) - 1st Session
ACCURACY IN MEDICARE PHYSICIAN PAYMENT ACT OF 2013; Congressional Record Vol. 159, No. 95
(Extensions of Remarks - June 28, 2013)
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[Extensions of Remarks] [Page E992] From the Congressional Record Online through the Government Publishing Office [www.gpo.gov] ACCURACY IN MEDICARE PHYSICIAN PAYMENT ACT OF 2013 ______ HON. JIM McDERMOTT of washington in the house of representatives Thursday, June 27, 2013 Mr. McDERMOTT. Mr. Speaker, I rise today to introduce the Accuracy in Medicare Physician Payment Act of 2013. This bill will give the Centers for Medicare and Medicaid Services (CMS) important tools and resources to continue alleviating our dire shortage of primary care physicians. As Congress tries to come together around the challenges of how to repeal and replace the broken Sustainable Growth Rate formula, I want to make sure that we do not neglect the Medicare physician fee schedule and the impact it has on our physician workforce. It is no mystery that relatively depressed salaries are driving new doctors away from primary-care fields like family medicine and pediatrics and into more lucrative specialties and subspecialties like radiology and orthopedic surgery. I don't begrudge anyone for making that choice; when I graduated from medical school 50 years ago I could not have fathomed being loaded down with six figures of medical school debt. And to be sure, we need talented specialists. But we have a stubbornly small proportion of primary care doctors--just over 30 percent, when most experts agree that 50 percent is the ``sweet spot'' in terms of maximizing quality and minimizing cost. I am proud that Congress gave primary care a shot in the arm in the Affordable Care Act, under which Medicaid pays higher Medicare rates for primary care through 2015, and Medicare makes quarterly incentive payments to primary care physicians through 2017. The ACA also expanded the National Health Service Corps, which eases the steep cost of medical education for doctors and allied health practitioners willing to practice in an underserved area after graduation. These are meaningful steps, but to make more enduring progress in this area, I believe that Medicare must repair structural inaccuracies in the Medicare physician fee schedule that have eroded the value of primary care. Simply put, Medicare contributes to this imbalance by underpaying for the critical yet undervalued job of managing complex patients with multiple chronic conditions and keeping them out of the emergency room and hospital. A major obstacle to reform is Medicare's continued reliance on a committee of mostly specialist physicians to help set payment rates for the 7,400 services on the Medicare physician fee schedule. Since 1991, Medicare has outsourced its work of appraising the value of these services to the AMA's Relative Value Scale Update Committee (RUC)--a 31-member panel of physicians who decide how services should be valued and updated. Only a handful of the 31 committee members perform primary care. The RUC meets in private and provides limited release of the minutes of its proceedings. In formulating its recommendations, the RUC also relies heavily on anecdotal and self-serving surveys, rather than forensic evidence. CMS has begun to update misvalued codes in the fee schedule, but it needs more muscle and resources to do the job. This bill would establish a panel of independent experts within CMS that would identify the distortions in the fee schedule and develop evidence to justify more accurate updates. Medicare could continue to request work from the RUC, but the expert panel would both initiate such requests and review RUC's work product. The panel members would not have a direct interest in the fee schedule, and would include beneficiary representatives. It would be subject to the Federal Advisory Committee Act, which requires advisory bodies to hold open meetings and publish the minutes of such meetings. In addition to payment accuracy and fairness, this is also about reining in a conflict of interest. After looking at this for several years I believe that we give the physician specialty societies, through the RUC, an undue influence on their own payments. In no other area-- whether it be hospitals, skilled nursing facilities, or any other setting--does Medicare ask the providers to play such an active role in setting their own reimbursement amounts. Medicare certainly needs clinical expertise to evaluate the resources necessary to perform physician services but should not look to an outside organization whose members directly benefit from the fee schedule to apportion some $70 billion in annual public spending, without some checks and balances. No matter how well-intentioned, such a system contains structural biases that need safeguards to prevent abuse. Medicare is not only one of America's most important social insurance programs and a bulwark of the middle class, it also establishes economic incentives that ripple through all of health care and contribute to our shortage of primary care physicians. As we continue to pursue a permanent doc fix, let's also talk about how we will use Medicare to incentivize the appropriate mix of physicians in the workforce to serve beneficiaries and the public health. ____________________