PHYSICIAN PAYMENT STUDIES.

SEC. 4055. PHYSICIAN PAYMENT STUDIES. (a) Definitions of Medical and Surgical Procedures.— (1) Report on variations in carrier payment practice.— The Secretary of Health and Human Services (in this section referred to as the “Secretary”) shall conduct a study of variations in payment practices for physicians’ services among the different carriers under section 1842 of the Social Security Act. Such study shall examine carrier variations in the services included in global fees and pre- and post-operative services included in payment for the operation. The Secretary shall report to Congress on such study by not later than May 1, 1988. (2) Uniform definitions of procedures for payment purposes.— The Secretary shall develop, in consultation with appropriate national medical specialty societies and by not later than July 1, 1989, uniform definitions of physicians’ services (including appropriate classification scheme for procedures) which could serve as the basis for making payments for such services under part B of title XVIII of the Social Security Act. In developing such list, to the extent practicable— (A) ancillary services commonly performed in conjunction with a major procedure would be included with the major procedure; (B) pre- and post-procedure services would be included in the procedure; and (C) similar procedures would be listed together if the procedures are similar in resource requirements. (b) Expansion Of Relative Value Scale (RVS) Study.— (1) Additional services.— The Secretary shall expand the study being conducted, under section 1845(e) of the Social Security Act, to develop a relative value scale for physicians’ services to include physicians’ services in the fields of cardiology, dermatology, emergency medicine, gastroenterology, hematology, infectious disease, nephrology, neurology, neurosurgery, nuclear medicine, oncology, physical medicine and rehabilitation, plastic surgery, pulmonary medicine, and radiation therapy, and for physicians who specialize in osteopathic procedures. (2) No delay in current study.— The expansion under paragraph (1) shall not be conducted in a manner that delays the completion of the current study or the report to Congress required under section 1845(e)(3) of the Social Security Act. The Secretary shall report to Congress on the services described in paragraph (1) by not later than October 1, 1989. (3) Prompt submittal of study results to physician payment review commission.— The Secretary shall submit to the Physician Payment Review Commission a copy of any report submitted to the Secretary pursuant to a cooperative agreement in the fulfillment of the requirement of section 1845(e) of such101 STAT. 1330–99 Act, with all relevant supporting data (including survey data, analytic data files, and file documentation), by no later than 30 days after the date the final report is received by the Secretary. (c) Other Physician Payment Studies.— (1) Fee schedule implementation.— The Secretary shall conduct a study of changes in the payment system for physicians’ services, under part B of title XVIII of the Social Security Act, that would be required for the implementation of a national fee schedule for such services furnished on or after January 1, 1990. Such study shall identify any major technical problems related to such implementation and recommendations on ways in which to address such problems. The Secretary shall report to the Congress on such study by not later than July 1, 1989. (2) Volume and intensity of physician services.— The Secretary shall conduct a study of issues relating to the volume and intensity of physicians’ services under part B of title XVIII of the Social Security Act, including— (A) historical trends with regard to increases in the volume and intensity of physicians’ services furnished on a per enrollee basis (with appropriate adjustments to account for changes in the demographic composition of the medicare population); (B) geographic variations in volume and intensity in physicians’ services; (C) an analysis of the effectiveness of methods currently used under such part to ensure that payments under such part are made only for services which are medically necessary; (D) the development and analysis of alternative methods to control the volume of services; and (E) the impact of the implementation of the relative value scale developed under section 1845(e) of such Act on the volume and intensity of physicians’ services. The Secretary shall submit to Congress an interim report on such study not later than May 1, 1988, and a final report on such study not later than May 1, 1989. (3) Survey of out-of-pocket costs of medicare beneficiaries for health care services.— The Secretary shall conduct a survey to determine the distribution of— (A) the liabilities and expenditures for health care services of individuals entitled to benefits under title XVIII of the Social Security Act, including liabilities for charges (not paid on an assignment-related basis) in excess of the reasonable charge recognized, and (B) the collection rates among different classes of physicians for such liabilities, including collection rates for required coinsurance and for charges (not paid on an assignment-related basis) in excess of the reasonable charge recognized. The Secretary shall report to Congress on such study by not later than July 1, 1990. (d) Study of Payment for Chemotherapy in Physicians’ Offices.— (1) In general.— The Secretary shall study ways of modifying part B of title XVIII of the Social Security Act to permit adequate payment under such part for the costs associated with providing chemotherapy to cancer patients in physicians’ of-101 STAT. 1330–100fices. The study shall be performed in consultation with physicians and other health care providers who are experts in cancer therapy and with representation of health insurers who have experience in these payment issues. (2) Report.— The Secretary shall report to Congress on the results of the study by not later than April 1, 1989.