Healthcare Business News

AMA's criticism of CMS' new physician fee schedule is misdirected

By Modern Healthcare
Posted: August 24, 2013 - 12:01 am ET

Regarding “Reform Update: AMA blasts new Medicare physician fee schedule, defends RUC," the American Medical Association is misdirecting its criticism of the CMS' “arbitrary new policy” to lower office payments when reimbursement is higher than if the service is performed in a hospital outpatient department (OPD) or ambulatory surgery center (ASC).  This argument is specious. According to the July 19 Federal Register, payment reduction will occur when the service “furnished in the physician office setting exceeds the total Medicare payment when the service is furnished in an OPD or an ASC.” In other words, when the office compensation is greater than the professional service plus facility fee for the institutional setting. What the AMA should be protesting is the extra facility payment hospitals receive, which help them offset their other costs and finance the purchase of physician practices.

Dr. Joel Shalowitz
Clinical professor and director of health industry management
Kellogg School of Management and professor of preventive medicine,Feinberg School of Medicine, Northwestern University
Evanston, Ill.

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