103 STAT. 2186 PUBLIC LAW 101-239—DEC. 19, 1989 Reports. Reports. Reports. tions of existing codes, and the ability to audit ph3rsician time accurately. (5) COMMISSION STUDY OF PAYMENT FOR PRACTICE EXPENSES. — The Physician Payment Review Commission shall conduct a study of— (A) the extent to which practice costs and malpractice costs vary by geographic locality (including region, State, Metropolitan Statistical Areas, or other areas and by spe- cialty), (B) the extent to which available geographic practice-cost indices accurately reflect practice costs and malpractice costs in rural aresis, (C) which geographic units would be most appropriate to use in measuring and adjusting practice costs and mal- practice costs, (D) appropriate methods for allocating malpractice ex- penses to particular procedures which could be incor- porated into the determination of relative values for particular procedures using a consensus panel and other appropriate methodologies, (E) the effect of alternative methods of allocating mal- practice expenses on medicare expenditures by specialty, t3rpe of service, and by geographic area, and (F) the special circumstances of rural independent labora- tories in determining the geographic cost-of-practice index. By not later than July 1, 1991, the Commission shall submit a report to the Committees on Ways and Means and Energy and Commerce of the House of Representatives and the Committee on Finance of the Senate on the study and shall include in the report such recommendations as it deems appropriate. (6) COMMISSION STUDY OF GEOGRAPHIC PAYMENT AREAS.—The Physician Payment Review Commission shall conduct a study of the feasibility and desirability of using Metropolitan Statistical Areas or other payment areas for purposes of payment for physicians' services under part B of title XVIII of the Social Security Act. By not later than July 1, 1991, the Commission shall submit a report to Congress on such study and shall include in the report recommendations on the desirability of retaining current carrier-wide localities, changing to a system of statewide localities, or adopting Metropolitan Statistical Areas or other payment areas for purposes of payment under such part B. (7) COMMISSION STUDY OF PAYMENT FOR NON-PHYSICIAN PROVID- ERS OF MEDICARE SERVICES. —The Physician Payment Review Commission shall conduct a study of the implications of a resource-based fee schedule for physicians' services for non- physician practitioners, such as physician assistants, clinical psychologists, nurse midwives, and other health practitioners whose services can be billed under the medicare program on a fee-for-service basis. The study shall address (A) what the proper level of payment should be for these practitioners, (B) whether or not adjustments to their payments should be subject to the medicare volume performance standard process, and (C) what update to use for services outside the medicare volume perform- ance standard process. The Commission shall submit a report to Congress on such study by not later than July 1, 1991.
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