The AMA has also been contacting legislators trying to defend its valuations after The Post’s investigation found that many of the values placed on procedures are based on flawed assumptions regarding how long those procedures take.
By federal law, the values are supposed to be based on the time and intensity of the procedures. The values, in turn, determine what Medicare and most private insurers pay doctors.
But The Post found that the AMA’s estimates of the time involved in many procedures are exaggerated, sometimes by as much as 100 percent, and that if the time estimates are to be believed, some doctors would have to be averaging more than 24 hours a day to perform all the procedures they are reporting.
Many of the doctors achieving this seemingly miraculous proficiency were gastroenterologists.
In their response to members of Congress and the public, the AMA offered statistics indicating that gastroenterologists perform only six to eight procedures per day on average.
The AMA figure, however, appears to be a daily average. As the data reviewed by The Post show, many doctors primarily schedule their procedures for certain weekdays. It is on those days, not reflected in a daily average, that doctors rack up the high volumes that make the AMA time estimates improbable.
The legislators are clearly concerned about the problem of how doctor services are priced.
“A lack of accurate and meaningful data on costs has hampered the ability of Medicare to review the accuracy of payments for services and identify which services are improperly valued,” according to a fact sheet issued Monday by the House Energy and Commerce Committee.
But McDermott, a physician and longtime critic of the AMA process for setting values, would like to go further in overhauling the system than the current bill.
He has introduced separate legislation that would create a federal advisory committee that would weigh in on the values that determine physician pay — essentially giving the government an alternative to the recommendations of the AMA.
“I’m not anti-doctor,” said McDermott, who once was a practicing psychiatrist. “But there has to be some reality here.”