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Secret Doctor Panel Story

Uproar builds over secret doctor panel influencing Medicare

Chicago, IL — Imagine this: A secret panel of 31 doctors who meet every year to decide what every major medical procedure, test and treatment should cost.  Sounds like a conspiracy, no?  But it isn’t.

 

In the shortest and most general of terms, here’s how medical costs work: Commercial insurers generally charge what Medicaid charges (although often more, and often a lot more).  Medicaid generally charges what Medicare charges.  And Medicare generally charges what the Relative Value Scale Update Committee (RUC for short) recommends it charge.

 

The RUC is an internal panel of the American Medical Association (AMA), the largest and most powerful medical professional and lobbying group.

 

The RUC’s 31 members meet each year to review the current associated time/work, overhead expenses, and malpractice costs of every major medical procedure, test and treatment—and then use that current information to slap a suggested price tag on each.

 

Those suggestions are then passed on to the federal Centers for Medicare and Medicaid Services (CMS)—which traditionally has adopted just under 70 percent of the annual recommendations.

 

The news now is that this time around, Medicare is indicating it will agree with close to 100 percent of the RUC’s recommendations—in turn triggering industry-wide protest.

 

A number of advocacy groups, primary-care doctors and other critics believe that Medicare’s increased deference to the RUC’s price recommendations for 2018 is a conflict of interest that steers federal spending toward more expensive procedures and distorts Medicare rates in favor of certain medical specialties.

 

The RUC’s 2018 recommendations—all 3,200 pages of them—are controversial because it means that a secret group of doctors are essentially deciding their own pay, arguably skewing it favor of higher-paid specialists who tend to charge more than primary care.

 

“There is evidence that certain procedures are overpriced,” the independent Medicare Payment Advisory Commission wrote in a letter, “and CMS is missing an opportunity to address this inequity.”