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AAOS Sends Letter to MedPAC re: Specialty Care

On January 10, 2018, AAOS joined a number of surgical organizations in sending a letter to the Medicare Payment Advisory Commission (MedPAC) regarding a discussion on the physician fee schedule (PFS) and primary care services. Specifically, the letter questions the problems that MedPAC describes with the way the PFS pays for primary care, the concerns with income disparities between specialties, and the effectiveness of increasing payment to certain specialties as a means to address workforce issues.

“Primary care clinicians should be paid for the value of the care that they provide [and it] is possible that this could result in increased payment for primary care,” the letter states. “But to suggest that the increase must necessarily come at the expense of other providers shows a fundamental misunderstanding of the current and developing workforce shortages for specialties, the reasons that medical students select future career paths, and a disregard for the stress that has been placed on the entire Medicare system by, at best, stagnant reimbursements.”

As stated in the letter, the participating organizations are committed to relative payment accuracy under the Medicare PFS and are committed to efforts to improve quality and resource use measurement. But the letter notes that a discussion that focuses, not on whether Medicare is appropriately valuing services or measuring the quality of services for Medicare beneficiaries, but rather on a “rebalancing” of the PFS where MedPAC tries to engineer medical specialty selection via tinkering with Medicare payments as a tangential way to address the serious workforce shortages faced by the United States, is a misplaced effort that fails to take into account the impact on the entire health care delivery system and needs of patients both now and in the future. “We urge MedPAC to redirect its efforts to those that will truly improve the accuracy of Medicare payments and improve the quality and efficiency of care for Medicare beneficiaries,” the letter concludes.