DC journalists dig into secrets behind AMA’s physician payment committee

Joseph Burns

About Joseph Burns

Joseph Burns (@jburns18), a Massachusetts-based independent journalist, is AHCJ’s topic leader on health insurance. He welcomes questions and suggestions on insurance resources and tip sheets at joseph@healthjournalism.org.

A secretive committee of the American Medical Association exaggerates how much physician time and effort is involved in performing many medical procedures, according to an analysis of the committee’s work by journalists at The Washington Post.

That exaggeration skews payment in favor or physician specialists and at the expense of primary care physicians, according to the article by the Post’s Dan Keating (@dtkeating) and Peter Whoriskey (@PeterWhoriskey).

The claim that the committee overstates the time involved to do many procedures has been reported previously. What is unusual about Keating and Whoriskey’s analysis of the AMA’s 31-member Relative Value Update Committee is that they calculated the committee’s estimates of the time involved for physicians to do many procedures and found the numbers to be off by as much as 100 percent in favor of specialist physicians.

Their work is important because the committee’s calculations are the basis for what the federal Centers for Medicare & Medicaid Services and most private health insurers pay for specialty care. Critics say the RUC’s recommendations have resulted in relatively higher pay for specialists and lower pay for primary care physicians (PCPs), a factor that may be causing a shortage of PCPs.

The committee meets in private every year to estimate the time involved to do most of the services doctors perform, Keating and Whoriskey report. “If the time estimates are to be believed, some doctors would have to be averaging more than 24 hours a day to perform all of the procedures that they are reporting,” they wrote. “This volume of work does not mean these doctors are doing anything wrong. They are just getting paid at the rates set by the government, under the guidance of the AMA.”

For a new “How I did it” article, Keating and Whoriskey explain the methods they used in collecting data for this story and what has happened since the article was published. They explain, for example, how data CMS publishes annually include rates for physician compensation for more than 6,000 procedures, services and tests. Then, they go into detail about how using the data requires understanding three components of the compensation formula: how much to pay the doctor, how much to pay for the facility where the procedure takes place and how much to pay for medical malpractice insurance premiums related to that procedure. Then, CMS adjusts payment based on geographic variations for cost of living and medical malpractice costs.

Read more about their work.

1 thought on “DC journalists dig into secrets behind AMA’s physician payment committee

  1. Pingback: “DC Journalists Dig Into Secrets Behind AMA’s Physician Payment Committee” | Teresa Shipley

Leave a Reply

This site uses Akismet to reduce spam. Learn how your comment data is processed.