A primary-care physician practice in Augusta, Ga., has filed federal litigation alleging that for decades the CMS has illegally relied on biased advice (PDF) from the American Medical Association in setting its payment formulas for general and specialty doctors.
CMS relies on biased AMA data, docs allege
As a result, the litigating doctors say, the CMS has consistently overpaid specialty doctors relative to primary-care physicians, which has made it more difficult for much-needed general medical clinics to stay in business. The lawsuit was filed by five physicians and a dentist who all work at the Center for Primary Care in Augusta.
CMS spokesman Brian Cook declined to comment on the allegations.
The doctors' lawsuit filed in U.S. District Court in Baltimore says that since 1992 the CMS has relied on an obscure committee of the AMA known as the Relative Value Scale Update Committee to advise it on how to set Medicare reimbursement rates for various medical specialties based on changes in the cost of providing services.
Critics say the specialty data is distorted and does not adequately measure the value of primary-care doctors, leading to financial discrepancies even after the Patient Protection and Affordable Care Act ordered the CMS to bring primary-care rates more in line with specialties.
The lawsuit seeks a judicial ruling to order the CMS to stop using fee schedules based on AMA information. Meanwhile, Rep. Jim McDermott (D-Wash.) has introduced legislation in the House that would require the CMS to consider other sources of data when setting the physician payment rates.
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