The Federal Trade Commission staff has advised the American Medical Association (AMA) that its proposal to disseminate to the public information relating to proposed revisions to Medicare’s resource-based relative value scale (RBRVS) does not appear to violate the antitrust laws. In a letter to AMA’s Group Vice President, Kirk B. Johnson, Robert F. Leibenluft, Assistant Director for Health Care in the FTC’s Bureau of Competition, said this information “may be of value to providers, payers, and the public; consequently, dissemination of the information may provide procompetitive benefits.”
Medicare pays for physician services according to an RBRVS that assigns numerical values to different medical and surgical procedures. These values are converted into fees by applying a dollar conversion factor and a geographic adjustment factor.The Health Care Financing Administration (HCFA) updates the RBRVS annually, and is required to review the RBRVS every five years. In order to help provide input from the physician community to the RBRVS updating process, AMA created the American Medical Association/Specialty Society RVS Update Committee (RUC). The Update Committee makes recommendations to HCFA with respect to the physician work component of the relative value units contained in the RBRVS.
The AMA said that the Update Committee has generated a substantial volume of information that could be valuable to third-party payers and to providers. While the relative values recommended by the Update Committee are made public by HCFA, the rationale and data underlying the recommendations are, for the most part, not public. AMA proposes to make available to the public the data submitted to HCFA by the Update Committee, including the rationales for the recommendations and the vignettes and surveys used to generate the specialty society proposed values. AMA believes this information would help physicians understand the services described by the service codes used in the RBRVS, and help private payers evaluate the RBRVS and adapt it to their own use. AMA states that it does not intend to issue its own RBRVS.
The Leibenluft letter states in part that: “[r]elease by a physician organization of information relating to pricing of physician services could raise concerns under the antitrust laws if it evidenced or facilitated an agreement on prices or other terms of dealing by competing providers, or an agreement to deal with payers only on certain terms. However, there is no reason to believe that such effects are likely to flow from the dissemination of the RUC information in the circumstances disclosed by this request. Indeed, since the relative values recommended by the RUC ultimately are made public by HCFA, the release of information explaining the bases for those recommendations is more likely to be procompetitive by assisting the public in evaluating the RUC’s recommendations.”
NOTE: This letter sets out the views of the staff of the FTC's Bureau of Competition, as authorized by the Commission's Rules of Practice. It has not been reviewed or approved by the Commission. As the Commission's rules explain, the staff's advice is rendered "without prejudice to the right of the Commission later to rescind the advice and, where appropriate, to commence an enforcement proceeding."
Copies of the letter are available from the FTC's Public Reference Branch, Room 130, 6th Street and Pennsylvania Avenue, N.W., Washington, D.C. 20580; 202-326-2222; TTY for the hearing impaired 1-866-653-4261. To find out the latest news as it is announced, call the FTC NewsPhone recording at 202-326-2710. FTC news releases and other materials also are available on the Internet at the FTC’s World Wide Web site at: http://www.ftc.gov