Medicare Physician Fees: Geographic Adjustment Indices Are Valid in Design, but Data and Methods Need Refinement;Report to the Congress

摘要

The Medicare physician fee schedule adjusts physician fees for area differences in physicians costs of operating a private medical practice. Three separate indices, known as geographic practice cost indices (GPCI), raise or lower Medicare fees in an area, depending on whether the areas physician practice costs are above or below the national average. e three GPCIs correspond to the three components of a Medicare fee: physician work, practice expense, and malpractice expense. Advocates for rural physicians have criticized the GPCIs, which lower fees in areas where costs are below the national average. The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 directed GAO to evaluate Medicares method of geographic adjustment. This report examines the extent to which Medicares GPCIs are valid in their design and appropriate in the data and methods used in their construction, and affect physician incomes, location, recruitment, and retention. GAO recommends that HHS improve the GPCIs by augmenting the data and refining the methods used to construct them. HHS characterized GAOs findings as important but disagreed with most of the recommendations, citing concerns about when they could be implemented. GAO holds that its recommendations account for these timing issues.