Dive Brief:
- A new report by the Government Accountability Office suggests the government should rely less on advice from physician in deciding Medicare fees because of concerns that they are providing biased and sometimes faulty information.
- According to the GAO, Medicare officials have typically accepted the recommendations provided by a committee of 31 doctors from the American Medical Association and medical specialty societies.
- The report validates criticism of the process that has been ongoing for years.
Dive Insight:
The government is between a rock and a hard place in acquiring physician advice. On the one hand, as critics argue, physicians who serve Medicare beneficiaries have conflicts of interest and may trend toward recommending higher values for the types of services they perform. However, as supporters argue, only the physicians perfoming services can provide the necessary level of expertise required to determine fair rates.
A particular sticking point has been lower representation and rates provided for primary care services compared to specialty services. The American Academy of Family Physicians argues that the advisory panel should include more primary care doctors, consumer representatives, employers and healthcare economists.
In addition, some are questioning the accuracy of surveys colected by medical societies and utilized to gather data on their members' work. The GAO points out that response rates can be low and that Medicare officials are unable to independently verify the data.