[Congressional Record Volume 161, Number 87 (Tuesday, June 2, 2015)]
[Extensions of Remarks]
[Page E820]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




         THE ACCURACY IN MEDICARE PHYSICIAN PAYMENT ACT OF 2015

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                           HON. JIM McDERMOTT

                             of washington

                    in the house of representatives

                         Tuesday, June 2, 2015

  Mr. McDERMOTT. Mr. Speaker, today I am proud to introduce the 
Accuracy in Medicare Physician Payment Act, legislation that will 
provide the Centers for Medicare and Medicaid Services (CMS) with 
important tools that will strengthen primary care in this country.
  For too long, Medicare has relied upon a flawed process to set 
payment rates for services on the physician fee schedule. Since 1991, 
CMS has outsourced the process of valuing physician services to the 
Relative Value Scale Update Committee (RUC), a secretive 31-member 
panel of doctors. The RUC's composition is shaped by the American 
Medical Association, and specialty societies are grossly 
overrepresented in its membership. As a private entity, the RUC is 
exempt from transparency laws, and the justifications for the 
committee's recommendations are opaque.
  The RUC is extremely influential. From 1994 to 2010, CMS accepted 
approximately 90 percent of the committee's recommendations, and--
although that rate has declined in recent years--the RUC continues to 
exert tremendous power over Medicare. This has far reaching 
implications for the entire American healthcare system, as Medicare's 
rates strongly influence the reimbursement rates of private insurers.
  Meanwhile, our country faces a growing crisis in its primary care 
workforce. The Health Resources and Services Administration estimates 
that there will be a nationwide shortage of over 20,000 primary care 
doctors by 2020. Primary care providers--particularly those who 
practice in low-income and rural areas--are compensated at much lower 
rates than specialists. Recent medical graduates, who on average are 
saddled with about $170,000 in educational debt, are steered away from 
lower-paying work in primary care toward lucrative specialties. This 
leaves millions of Americans without access to the care they need, 
threatening their health security and ultimately driving up healthcare 
costs for the entire country.
  By distorting payment rates in favor of specialty services, the RUC 
has had a direct role in creating this crisis. Calls to reform its 
processes are growing. A recent report by the Government Accountability 
Office has called into question the accuracy of the RUC's 
recommendations due to weaknesses in its data collection methods and 
conflicts of interest by its members.
  The Accuracy in Medicare Physician Payment Act will reform this 
flawed system. It will give CMS the tools it needs to ensure that 
payment rates serve the needs of the American people, not the needs of 
highly-compensated specialists. This legislation will establish an 
independent panel of experts within CMS that will identify distortions 
in payment rates and help Medicare develop evidenced-based updates to 
the fee schedule. Its processes will be highly transparent and it will 
be subject to the Federal Advisory Committee Act, which requires 
advisory bodies to hold open meetings and publish minutes. If 
necessary, CMS may still seek input from the RUC, but all 
recommendations would be carefully scrutinized by the expert panel.
  This legislation will ensure that the process of setting physician 
payment rates is subject to rigorous oversight, independent analysis by 
experts, and meaningful transparency. It will put an end to a flawed 
process that has contributed to a healthcare system that drives 
thousands of young doctors away from where they are needed most.

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