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WASHINGTON — Doctors are splitting, specialty by specialty, over whether and how to overhaul a secretive panel that helps determine how much Medicare pays them for their work.

Doctors who get paid more by Medicare generally like the way the panel operates now. But doctors who are paid relatively less are looking for ways they say would make the process more fair. And Medicare officials are clearly considering the issue: their latest regulations included more than 20 pages dedicated to the topic of whether the process needs an overhaul.

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Right now, Medicare decides how much to pay certain physicians relative to one another based on advice from a committee of the American Medical Association, the national advocacy group representing the profession. That committee determines how much work and resources a given medical service entails and thus how much money it should be paid for through Medicare.

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