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Washington Post Article Questions AMA's Role in Establishing Medicare Prices — Physician’s First Watch

Medical News |
July 22, 2013

Washington Post Article Questions AMA's Role in Establishing Medicare Prices

By Joe Elia

The Washington Post casts a skeptical eye on how Medicare sets prices it pays physicians for procedures — and the American Medical Association's role.

Taking colonoscopy as an example, the AMA estimates that the procedure takes 75 minutes of a physician's time, whereas published studies indicate otherwise. "Indeed," according to the Post, "the standard appointment slot is half an hour." The writers point to one Florida ophthalmologist who performed nearly 4000 procedures last year, averaging over 30 AMA "procedure hours" each on Mondays and Tuesdays while actually working about 10 hours on those days.

The AMA makes visitors to its "Relative Value Update Committee" meetings sign nondisclosure agreements, and because its role is voluntary the meetings aren't open. The government uses the committee's recommendations to adjust its payments each year.

A former Medicare chief told the Post: "The idea that $100 billion in federal spending is based on fixed prices that go through an industry trade association in a process that is not open to the public is pretty wild."

Reader Comments (1)

ab1p@verizon.net Physician, Psychiatry, private practice

Not only is that method of determining pricing "wild" it notably pays those of us who use our brains instead of procedure instruments getting reimbursed in amounts that don't even cover our overhead. That's beyond wild. That's a professional association deciding that some of it's member's jobs are worth more than others.

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