Medicare Physician Payment Transparency and Assessment Act of 2011

Medicare Physician Payment Transparency and Assessment Act of 2011 - Amends title XVIII (Medicare) of the Social Security Act, as amended by the Patient Protection and Affordable Care Act, to direct the Secretary of Health and Human Services (HHS) to identify physician services annually (currently, periodically) as being potentially misvalued using specified criteria.

Authorizes the Secretary to use existing processes to receive recommendations on the review and appropriate adjustment of potentially misvalued physician services, but only to the extent consistent with the use of analytic contractors.

Requires the Secretary of HHS to use analytic contractors to identify, and analyze services identified as being, potentially misvalued physician services, and perform related tasks as currently authorized.

[Congressional Bills 112th Congress]
[From the U.S. Government Publishing Office]
[H.R. 1256 Introduced in House (IH)]

112th CONGRESS
  1st Session
                                H. R. 1256

 To amend title XVIII of the Social Security Act to require the use of 
 analytic contractors in identifying and analyzing misvalued physician 
services under the Medicare physician fee schedule and an annual review 
        of potentially misvalued codes under that fee schedule.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             March 30, 2011

Mr. McDermott introduced the following bill; which was referred to the 
 Committee on Energy and Commerce, and in addition to the Committee on 
   Ways and Means, for a period to be subsequently determined by the 
  Speaker, in each case for consideration of such provisions as fall 
           within the jurisdiction of the committee concerned

_______________________________________________________________________

                                 A BILL


 
 To amend title XVIII of the Social Security Act to require the use of 
 analytic contractors in identifying and analyzing misvalued physician 
services under the Medicare physician fee schedule and an annual review 
        of potentially misvalued codes under that fee schedule.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE; FINDINGS.

    (a) Short Title.--This Act may be cited as the ``Medicare Physician 
Payment Transparency and Assessment Act of 2011''.
    (b) Findings.--Congress finds the following:
            (1) The Centers for Medicare & Medicaid Services (CMS) has 
        not had sufficient resources or commitment to undertake the 
        needed surveys and analytic research needed to keep the 
        Medicare resource-based relative value scale (RBRVS) current 
        with changes in medical, surgical, consultative, procedural, 
        and diagnostic practices. For the last 20 years, the American 
        Medical Association has sponsored the Specialty Society 
        Relative Value Scale Update Committee (RUC) as a good faith 
        effort to support CMS in the task of developing the physician 
        fee schedule but a more robust process is needed.
            (2) CMS has depended on the AMA's RUC for recommendations 
        as to the values assigned to Medicare service codes for over 90 
        percent of all code changes over the last 19 years.
            (3) Although primary care physicians provide about 44 
        percent of Medicare physician visits, they constitute only \1/
        6\ to \1/13\ of the membership of the RUC.
            (4) The RUC lacks voting transparency and relies on self-
        reported and unrepresentative survey data that present serious 
        conflict-of-interest concerns.
            (5) The Medicare Payment Advisory Commission has found that 
        while the RUC tends to identify and correct undervalued codes, 
        it does not have the same incentives to find and correct 
        overvalued codes. Specialists, especially those who derive the 
        majority of their income through procedural codes, have no 
        incentive to reduce the value of potentially overvalued codes, 
        even though the requirements for physician work in many 
        procedures should generally reduce as time passes and 
        proficiency increases.
            (6) The assignment of relative values to the evaluation and 
        management (E/M) codes was the most unsubstantiated component 
        of the original RBRVS and has not been systematically and 
        scientifically studied since the institutionalizing of RBRVS.
            (7) The advent of electronic health records will require 
        new methods to assess the intensity and work effort of the E/M 
        codes.
    (c) Purpose.--It is the purpose of this Act to require the 
Secretary of Health and Human Services to consider the recommendations 
of independent, analytic contractors that are responsible for initially 
identifying and analyzing misvalued Medicare physician services and to 
require an annual review of potentially misvalued codes under the 
Medicare fee schedule.

SEC. 2. REQUIRING USE OF ANALYTIC CONTRACTORS IN IDENTIFYING AND 
              ANALYZING MISVALUED MEDICARE PHYSICIAN SERVICES AND 
              ANNUAL REVIEW OF POTENTIALLY MISVALUED CODES UNDER 
              MEDICARE FEE SCHEDULE.

    Section 1848(c)(2)(K) of the Social Security Act (42 U.S.C. 1395w-
4(c)(2)(K)), as amended by section 3134(a) of the Patient Protection 
and Affordable Care Act (Public Law 111-148), is amended--
            (1) in clause (i), by striking ``periodically'' and 
        inserting ``annually''; and
            (2) in clause (iii)--
                    (A) subclause (I), by inserting before the period 
                at the end the following: ``, but only to the extent 
                consistent with the use of analytic contractors under 
                subclause (III)''; and
                    (B) in subclause (III)--
                            (i) by striking ``may use'' and inserting 
                        ``shall use''; and
                            (ii) by adding at the end the following: 
                        ``This subclause shall not be construed as 
                        prohibiting the Secretary from making 
                        modifications to one or more codes under the 
                        fee schedule without use of the analytic 
                        contractors.''.
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