The AMA's Dark Secret: Journalists aren't allowed inside the supposedly public meetings where the American Medical Association effectively decides (and ratchets up) health care prices.

AuthorGoozner, Merrill

The request seemed innocuous enough. In late April, I asked the American Medical Association if I could attend a meeting of the committee that largely determines the relative pay of various medical specialties.

The Relative Value Scale Update Committee (RUC) meets three times a year to consider changes and additions to the "relative value" of more than 10,000 billing codes in the Medicare physician fee schedule. Each year, in a textbook example of what economists call "agency capture," the Centers for Medicare and Medicaid Services (CMS) sets physician service prices based almost entirely on the RUC's recommendations, which systematically overweight technical skills like surgery and underweight the cognitive skills used in primary care. The RUC's 32-person roster includes one voting member for each of the 27 medical specialties recognized by the AMA.

The results are one of the primary roadblocks to achieving better health at lower costs from America's wildly overpriced health care system--the dearth of primary care physicians. Orthopedic surgeons and invasive cardiologists wind up earning, on average, more than $600,000 a year. In comparison, family physicians and pediatricians earn around $250,000, according to the latest Modern Healthcare survey of physician compensation consulting firms. The spread between the highest- and lowest-paid doctors has gone up by nearly $75,000 over the past decade--despite the AMA's insistence that it is taking steps to redress an imbalance that discourages more young doctors from entering primary care.

The AMA's public relations official, someone I've known for a long time, said he'd check if I could attend the meeting. A few hours later, he informed me via email that registration had closed two weeks earlier, and I needed to apply for media credentials at least a month in advance. Moreover, I would have to sign a nondisclosure agreement that would prevent me from writing about any "proprietary information" discussed at the meeting.

Since votes placing values on individual services are based on detailed surveys conducted by the various medical specialty societies of their memberships, virtually everything discussed at the meetings is "proprietary." It's no wonder not a single reporter attended the meeting, the first to discuss the 2024 physician fee schedule.

Well, what about the recommendations for the 2023 physician fee schedule, whose first draft will be issued by the CMS this summer? Could I at least get...

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