Robert F. Kennedy Jr. is considering an overhaul of Medicare's physician payment model.
Here are 10 things to know:
1. While the discussions are in the early stages, they involve a plan to review thousands of billing codes, according to four people who spoke anonymously with The Washington Post.
2. According to the Post, many healthcare leaders accuse the coding system of rewarding providers for surgeries and costly procedures.
3. Additionally, amid a growing shortage of primary care physicians, the system is also accused of pushing physicians toward becoming specialists, which pays more.
4. Although policymakers have highlighted the skewed incentives for years, the issue has received little national attention due to its complexity and the financial interests of powerful industry groups, according to the Post.
5. Medicare billing codes are developed through a collaboration between the American Medical Association and CMS. The AMA, through its Specialty Society RVS Update Committee (RUC), comprising dozens of physicians, evaluates the resources required for various medical services and advises CMS on appropriate reimbursement rates.
6. Historically, the allocation of Medicare payments has shifted significantly. In 1991, surgeons accounted for 32% of Medicare reimbursements, but by 2023, this figure had declined to 17.7%. During the same period, primary care’s share increased from 23.7% to 28.8%, according to an AMA spokesperson interviewed by Becker’s.
7. Concerns have been raised about the RUC’s methodology. A 2013 Washington Post investigation into colonoscopy procedures revealed that reimbursement recommendations often relied on inaccurate estimates of the time physicians spent on procedures, leading to inflated billing metrics.
8. The AMA has generated substantial revenue from its role in creating and maintaining billing codes, which includes selling educational materials and publications related to the coding system. The organization declined to comment when approached by The Washington Post for the investigation.
9. Reports indicate that Mr. Kennedy aims to collaborate with the AMA to revise billing codes in a way that prioritizes primary care services and addresses systemic health disparities.
10. According to a Politico report, Mr. Kennedy does not have a clear public view on Medicare and Medicaid, which could give prospective CMS Administrator Mehmet Oz, MD, significant control over CMS.