Medical care prices in the United States are not only the most expensive in the world, but there are wide variations in what physicians are paid. Doctors at the frontlines of medical care who manage complex conditions argue that they receive disproportionately lower fees than physicians performing services such as minor surgeries and endoscopies. Fixing Medical Prices goes to the heart of the U.S. medical pricing process: to a largely unknown yet influential committee of medical organizations affiliated with the American Medical Association that advises Medicare. Medicare’s ready acceptance of this committee’s recommendations typically sets off a chain reaction across the entire American health care system. For decades, the U.S. policymaking structure for pricing has reflected the influence of physician organizations. What Miriam Laugesen’s rich analysis shows is how these organizations navigate the arcane and complex work of this advisory committee. Contradicting the story of a profession in political decline, Fixing Medical Prices demonstrates that the power of physician organizations has simply become more subtle. Laugesen’s investigation into the exorbitant cost of American medical care will be of interest to those who follow the politics of health care policy, the influence of interest groups on rate setting, and the medical profession’s past and future role in our health care system.

Thirteen contributions discuss physician markets and Medicare benefits; alternatives for setting and adjusting fee schedules; and lessons learned from research, theory, and experience.

Medicare¿s physician fees may not always reflect efficiencies that occur when a physician performs multiple services for the same patient on the same day, and some resources required for these services do not need to be duplicated. This report examined: (1) the Centers for Medicare and Medicaid Services¿ (CMS) efforts to set appropriate fees for services furnished together; and (2) additional opportunities for CMS to avoid excessive payments when services are furnished together. The report examined relevant policies, laws, and regulations; interviewed CMS officials and others; and analyzed claims data to identify opportunities for further savings. Includes recommendations. Charts and tables.