How a secretive panel uses data that distorts doctors’ pay – the washington post electricity and magnetism review sheet


Dr. Amrit Narula, center, is one of the electricity a level physics managing partners of a colonoscopy clinic in Pottsville, Pa. Unknown to most, a single committee of the American Medical Association comes up with values for most of the services a physician performs — such as colonoscopies. But the AMA estimates of the time involved in many procedures are exaggerated. (Duncan Kendall/For The Washington Post)

●To determine how long a procedure takes, the AMA relies on surveys of doctors conducted by the associations representing specialists and primary care physicians. The doctors who fill out the surveys are electricity human body informed that the reason for the survey is to set pay. Increasingly, the survey estimates have been found so improbable that the AMA has had to significantly lower them, according to federal documents.

●If AMA estimates of time are correct, hundreds of doctors are working improbable hours, according to an analysis of records from surgery centers in Florida and Pennsylvania. In some specialties, more than one in five doctors would have to have been working more than 12 hours on average on a single day — much longer than the 10 hours or so a typical surgery center is open.

“What started as an advisory group has taken on a life of its own,” said Tom Scully, who was Medicare chief during the George W. Bush administration and is now gas monkey a partner in a private equity firm that invests in health care. “The idea that $100 billion in federal spending is based on fixed prices that go through an industry trade association in a process that is not open to the public is pretty wild.”

But she defended the accuracy of the gas out game commercial values assigned to procedures, saying that the committee is careful to make sure that the relative values of the procedures are accurate — that is, procedures involving more work are assigned larger values than those that involve less. It is up to Congress and private insurers then to assign prices based on those values.

Over the past decade, Medicare’s payments to doctors have electricity projects for grade 7 risen quickly. Medicare spending on physician fees per patient grew 58 percent between 2001 and 2011, mostly because doctors increased the number of procedures performed but also because the price of those procedures rose, according to MedPAC, an independent federal agency that advises Congress about Medicare.

Federal law makes the importance of time explicit: The work points assigned to a procedure will reflect the “physician time and intensity in furnishing the service” and includes the physician’s time before, during and after a procedure. Every year, the Medicare system publishes its time estimates for every service, which are based on AMA surveys.

The Post chose the 3 gases in the air outpatient surgery clinics for review because their surgery records for Medicare and private payers were publicly available. The calculations of physician gas 93 octane time used by The Post are conservative because they do not include the procedures that the doctors performed at hospitals, where many such doctors also see patients. The counts also exclude secondary procedures performed on a given patient, as well as follow-up visits.

Likewise, a New England Journal of Medicine article reported that in a study of 2,000 different colonoscopies, the average duration of the basic screening procedure was 13.5 minutes — not the 30 minutes estimated by the AMA. Similarly, it found that a colonoscopy with polyp removal took electricity lesson plans 4th grade 18 minutes — as opposed to the 43 minutes estimated by the AMA.

Yet despite these advances, the AMA and Medicare say the amount of work estimated in a colonoscopy essentially hasn’t budged. The work involved was 3.7 “relative value units” or points in the early 1990s; after more than two decades of labor-saving save electricity images advances, it is still worth 3.7 points. The typical Medicare price including overhead is about $220.

At Schuylkill Endoscopy, located in a tidy green building behind the McDonald’s in Pottsville, Pa., three doctors performed thousands of colonoscopies in 2011, taking in more than $700,000, along with hundreds of thousands more for other similar procedures. On top of those physician fees, the endoscopy clinic, which is owned by two of the physicians and a management company, took in $1.5 million in operating profits in 2011, according to state records.

The median salary for a gastroenterologist was $481,000 in 2011, according to data from the electricity for refrigeration heating and air conditioning 9th edition pdf Medical Group Management Association. By contrast, the median salary for a pediatrician was $204,000 and that of a general internal medicine doctor was $216,000. Those kinds of disparities are leading medical students away from primary care, critics say.