RFK Jr. eyes overhaul of Medicare physician pay: What to know

Robert F. Kennedy Jr. is exploring an overhaul of Medicare's physician payment model and looking to shift health incentives toward primary care and prevention, The Washington Post reported Nov. 21.

Here are six things to know:

1. The discussions are in the early stages, but involve a plan to review thousands of billing codes, according to four people who spoke anonymously with the Post.

2. Currently, the coding system is accused of rewarding providers for surgeries and costly procedures. It is also accused of pushing physicians toward becoming specialists, which pays more. Policymakers have highlighted the skewed incentives for years, but the issue has received little national attention due to its complexity and the financial interests of powerful industry groups, according to the report.

3. Medicare's billing codes are assessed by the American Medical Association and implemented by CMS. The AMA oversees the AMA/Specialty Society RVS Update Committee, made of several dozen physicians, who study the resources needed for each medical service and recommend reimbursements for those duties.

In 1991, prior to the establishment of the RUC, surgeons consumed 32% of Medicare payment charges. By 2023, it was down to 17.7%. Primary care went from 23.7% in 1991 to 28.8% in 2023, an AMA spokesperson told Becker's.

4. These recommendations have "historically been skewed by misleading estimates of how physicians spend their time," according to a 2013 Washington Post investigation of colonoscopies. For instance, The Post found that the RUC often inflated the amount of time a physician needed to perform a procedure, according to the report.

5. The AMA has collected millions of dollars in revenue from its work to develop and recommend billing codes. It also sells books and training around the codes. The AMA declined the Post's request for comment.

6. Mr. Kennedy is reportedly looking to work with the AMA on changes to billing codes that will promote primary care and reduce poor health outcomes in the nation.

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