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According
to the Government Accountability Office, the process the
Centers for Medicare & Medicaid Services uses to update
the fee schedule needs an overhaul itself --or else the
agency could jeopardize one all-important component: your
faith in the system.
In "CMS
Needs a Plan for Updating Practice Expense Component"
(GAO-05-60), the GAO warns that CMS' lack of a systematic
or timely review suggests the agency is not relying on the
best data.
How
it works: When estimating Medicare's payments for physicians'
operating costs, CMS looks at expense estimates from American
Medical Association physician surveys, as well as resource
estimates for individual services developed by expert panels
from a cross section of physician specialties.
According
to the GAO, the process is breaking down in three key areas:
* Falling
behind. CMS lacks a specific plan to ensure that it can
update the fee schedule on time. The AMA physician survey
that provides total practice expense data was last modified
in 2000. Some specialties continue to submit updates voluntarily,
but this is "not an appropriate substitute for a systematic
data collection effort," the report reads.
* Questionable
numbers. The GAO found evidence that CMS is using data that
does not properly represent physician practices within a
specialty, while arbitrarily rejecting more representative
data.
* Closed
doors. CMS modifies estimates made by expert panels without
always relying on adequate data or explaining the rationale
for its actions.
To read
the report, go to www.gao.gov/new.items/d0560.pdf.
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