The Trump administration is looking into alternatives to the current fee-for-service-based payment system for physicians who treat Medicare patients.
The request for information issued on July 14 by the Centers for Medicare & Medicaid Services (CMS) noted that the Current Procedural Terminology (CPT) coding system, on which the Medicare reimbursement program is based, is owned by the American Medical Association (AMA). The AMA assigns a CPT code to each service and procedure and then collects its own data to develop recommendations for CMS on how much each CPT code should be worth. "There has ... been longstanding concern expressed over the federal reliance on a private organization with such an obvious conflict of interest as providing information on the time and resource requirements to conduct physician services when this information may influence their own payment," the authors of the request stated.
"For nearly 20 years, MedPAC [the Medicare Payment Advisory Commission] has expressed concern over the influence of the AMA ... to value services, specifically noting that CMS has 'over-relied on specialty societies with a financial stake in the process' and has recommended that CMS establish a separate group of experts to make payment recommendations," they continued. In addition, "we note a recent National Academies of Sciences, Engineering, and Medicine report recommending ... alternatives for establishing primary care payment valuation and recommendations for alternative sources for data collection."
