AMA’S crit­i­cism of CMS mis­di­rected

Modern Healthcare - - OPINIONS / EDITORIALS -

Re­gard­ing “Re­form Up­date: AMA blasts new Medi­care physi­cian fee sched­ule, de­fends RUC” (, Aug. 12), 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.

What do you think?

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