Physician Fees

Medicare¿s physician fees may not always reflect efficiencies that occur when a physician performs multiple services for the same patient on the same day, and some resources required for these services do not need to be duplicated. This report examined: (1) the Centers for Medicare and Medicaid Services¿ (CMS) efforts to set appropriate fees for services furnished together; and (2) additional opportunities for CMS to avoid excessive payments when services are furnished together. The report examined relevant policies, laws, and regulations; interviewed CMS officials and others; and analyzed claims data to identify opportunities for further savings. Includes recommendations. Charts and tables.

Miriam Laugesen goes to the heart of U.S. medical pricing: to a largely unknown committee of organizations affiliated with the American Medical Association. Medicare’s ready acceptance of this committee’s advisory recommendations sets off a chain reaction across the American health care system, leading to high—and disproportionate—rate setting.