When Doctors set their (own) pay - Our view - USA Today

[Bill USA]

(emphases my own)

http://www.usatoday.com/story/opinion/2013/07/29/doctors-medicare-american-medical-association-editorials-debates/2598041/

[font size="3"]Is it any shock that AMA committee has often significantly overvalued medical procedures by specialists?[/font]


Some of the most important players in setting the rates that Medicare and private insurers pay doctors are — surprise — doctors themselves. And — no surprise — certain procedures end up costing more than they should.

Here's how the system works: A little-known committee run by the American Medical Association, the trade association for doctors, analyzes thousands of procedures that doctors perform and recommends "relative values" to Medicare. More often than not, Medicare accepts the AMA data for its own complex process of setting doctor reimbursement rates.

In some ways, this make sense. Who knows more about the complexities of medical procedures than the people who actually perform them? The AMA's Relative Value Update Committee volunteers for the job and spends huge amounts of time in numbingly detailed discussions about how to value what doctors do.

But the committee is also a flawed operation that operates in semisecret. The panel gathers its raw data by surveying doctors about the time and intensity of the procedures they perform — helpfully reminding physicians that the survey can help set their pay. Is it any shock that the committee has often significantly overvalued procedures by the cardiologists, ophthalmologists and other medical specialists who make up most of its 31 members?

In 2010, for example, The Wall Street Journal reported that the committee was under fire from medical experts for overstating the time it took to place a cardiac stent in a patient's artery or perform carpal tunnel surgery on someone's wrist.
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... there is more worth reading in the complete editorial