Medicare Compliance & Reimbursement

E/M services the focus as AMA looks at reimbursement rates.

The AMA's Relative Value Update Committee is conducting its third five-year review of relative value units this year, and this review is expected to focus on RVUs for evaluation and management services. Most physician codes already have been revised in the first two RVU updates, the committee said, which means very few RVUs are still based on the original study that launched the RVU system in 1992.

Further, far more codes saw increases in their RVUs rather than decreases during the first two five-year reviews, the commissioners said. This is partly because specialty societies are less likely to hear from their members about overvalued services, and CMS doesn't have the resources to identify these services. Sometimes physicians get more accustomed to new techniques, and can perform them more quickly, but the RVUs don't come down to reflect that efficiency.

The committee considered methods of measuring physicians' use of resources as a way of rewarding physicians for efficiency, but also to allow physicians to compare their performance with others.
 
One approach under consideration: Figure out which doctor was in charge of a patient's care, and then measure how much hospital care, medication and post-acute care the patient used. Then the surveyors could let the lead physician know how her use of resources for that patient compared with the average. The committee would aim to look at a national sample of patients.