Using Science to Shape Medicare Physician Payment

Aug. 12, 2013
JAMA Internal Medicine , Online First
Paul B. Ginsburg

The shortcomings of today’s relative value scale in general and the update process in particular were recognized by Congress, which included in the Patient Protection and Affordable Care Act steps that had been under discussion for some time. Section 3134 (Misvalued Codes Under the Physician Fee Schedule) requires review by the Centers for Medicare & Medicaid Services (CMS) for services most likely to be misvalued, such as those with the most rapid volume growth, new technologies for which relative values were recently established, and multiple codes that are frequently billed in conjunction with provision of a single service. The provision authorizes CMS to use analytic contractors to identify services for review, collect data, and make recommendations for changes in relative values. The level of attention at CMS to refine the relative value scale has clearly increased as a result of these provisions.

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