PUBLIC LAW 101-239—DEC. 19, 1989 103 STAT. 2183 pating physicians, (ID the proportion of expenditures for such services for which payment is made under this part on an assignment-related basis, and (III) the amounts charged above the recognized payment amounts under this part. "(B) REPORT.—The Secretary shall, by not later than April 15 of each year (beginning in 1992), report to the Congress regarding the changes described in subparagraph (A)(ii). "(C) PLAN.—If the Secretary finds that there has been a significant decrease in the proportions described in subclauses (I) and (II) of subparagraph (A)(ii) or an increase in the amounts described in subclause (III) of that subpara- graph, the Secretary shall develop a plan to address such a problem and transmit to Congress recommendations regarding the plan. The Physician Payment Review Commission shall review the Secretary's plan and rec- ommendations and transmit to Congress its comments regarding such plan and recommendations. ^ "(7) MONITORING OP unuzATiON AND ACCESS.— "(A) IN GENERAL.—The Secretary shall monitor— "(i) changes in the utilization of and access to serv- ices furnished under this part within geographic, popu- lation, and service related categories, "(ii) possible sources of inappropriate utilization of services furnished under this part which contribute to the overall level of expenditures under this part, and "(iii) factors underlying these changes and their interrelationships. "(B) REPORT.—The Secretary shall by not later than April 15, of each year (beginning with 1991) report to the Con- gress on the changes described in subparagraph (A)(i) and shall include in the report an examination of the factors (including factors relating to different services and specific categories and groups of services and geographic and demo- graphic variations in utilization) which may contribute to such changes. "(C) RECOMMENDATIONS.— The Secretary shall include in each annual report under subparagraph (B) recommenda- tions— "(i) addressing any identified patterns of inappropri- ate utilization, "(ii) on utilization review, "(iii) on ph3^ician education or patient education, "(iv) addressing any problems of beneficiary access to care made evident by the monitoring process, and "(v) on such other matters as the Secretary deems appropriate. The Physician Payment Review Commission shall comment on the Secretary's recommendations and in developing its comments, the Commission shall convene and consult a panel of physician experts to evaluate the implications of medical utilization patterns for the quality of and access to patient care. "(h) SENDING INFORMATION TO PHYSICIANS.— Before the beginning of each year (beginning with 1992), the Secretary shall send to each physician furnishing physicians' services under this part, for serv-
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