The Medicare Payment Advisory Committee (MedPAC) just released its annual report on Medicare expenditures.
Congress technically votes on the fees that Medicare pays, but it created MedPAC to serve as its primary advisor. If MedPAC sounds familiar to some, it may be because of reports in the past of the American Medical Association’s Relative Value Update Committee (RUC) and its influence on MedPAC. Washington Monthly published a great piece on the RUC “cartel” and how its secret deliberations by doctors who only care for one body part heavily influence the entire Medicare fee schedule. MedPAC historically approves over 90% of the RUC requests. Since the AMA is historically anti-family medicine and anti-generalism, this process history has a lot to do with the chronic anemic state of family medicine in the American healthcare system.
In MedPAC’s report, it “… remains concerned that the fee schedule and the nature of (fee for service) payment leads to an undervaluing of primary care and overvaluing of specialty care.” I would feel more positive about this, but MedPAC made similar statements 8 years ago, yet no substantive changes have occurred. To Medicare’s credit, it’s played around with some payment reform innovations, but too much of the status quo is unchanged. We use the same AMA CPT codes, the same documentation rules, the same coding rules, and the same limits on payment for comprehensive cognitive work. If you ever wondered why your doctor seemed rushed and did not want to discuss more than 1 or 2 issues with you, look no farther than the Medicare payment rules.
There are about 19 physicians in Congress and most of them are ologists. I know some of them grew up in the AMA political world, which means they won’t be inclined to disrupt the physician payment status quo.
The primary care shortage in this country continues to deepen, and Medicare is one of the biggest root causes of this problem. The conventional approach by politicians is to defer to doctors on issues of physician value and payment. It’s time for the non-medical elected officials to listen to its own commission and call for a new respect and payment approach for family medicine.
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