March 30, 2011

WASHINGTON, DC – Congressman Jim McDermott (D-WA), a senior member of the House Ways and Means Committee, introduced legislation aimed at ensuring that every family has access to a family doctor – i.e. a primary care physician.  The legislation seeks to address the income disparity that exists between primary care doctors and specialists, which is a major factor underlying the nation’s shortage of primary care physicians.

“Most people don’t know this, but there is this small panel that decides behind closed doors what the reimbursement rates will be for certain medical procedures,” said Congressman McDermott, who is a physician himself.  “For two decades now, this panel has been dominated by specialists who undervalue the essential and complex work of primary care providers and cognitive specialists, while often favoring unnecessarily complex, costly and excessive specialty medical services.  The result of this is clear – there is a shortage of family doctors, patients don’t necessarily get the services they need, and medical costs are increasingly driven higher.”

The bill, titled the “Medicare Physician Payment Transparency and Assessment Act of 2011” (H.R. 1256), would bring transparency to the American Medical Association’s Specialty Society Relative Value Scale Update Committee, also known as the “RUC.”  The RUC is responsible for making recommendations to the Centers for Medicare & Medicaid Services (CMS) on reimbursement rates – their recommendations are implemented over 90% of the time.  Moreover, since the creation of the RUC in 1991, the income disparity between primary care versus procedure-heavy specialists has grown from 61% to 89%. 

McDermott’s bill would expose the way CMS identifies and values health care services.  The bill would add public and transparent data collected from independent analysts to compare to the RUC’s recommendations.  The bill would use independent analytic contractors to conduct surveys and collect data for physician services paid under Medicare and to annually identify services that may be over or under-valued.

This bill is endorsed by the American Academy of Family Physicians (AAFP) and the Society of General Internal Medicine (SGIM). 

AAFP President, Dr. Roland Goertz, said, "Study after study has shown that primary medical care must be the foundation for a high-quality, efficient health care system.  If we are to build up our primary care physician workforce to create this foundation, we need a system that recognizes and appropriately rewards the medical expertise and cognitive skills of primary care physicians.  This legislation is an important step in that direction.  The Medicare Physician Payment Transparency and Assessment Act mandates that the Secretary of HHS use independent analytic contractors to collect data and surveys that complement the RUC process.  In doing so, this bill would help to assure the accuracy of payment codes for primary care relative to other physician services for use by CMS."

SGIM President, Gary Rosenthal, said, “Physician work values are the foundation of the physician payment system and must accurately reflect the work value and intensity of the services delivered to guarantee equitable physician reimbursement.  Evaluation and management services used for the primary care services must be reevaluated as the demands on physicians related to disease prevention and health promotion grow.  As an organization with a strong foundation in health services research, SGIM applauds Representative McDermott’s efforts to require analytic data to be used in valuing physician work and to address this important issue.”

A copy of the legislation as introduced can be found by clicking here.