Stifling Primary Care: Why does Medicare/Medicaid Still Support the “RUC” Rate Setting Cabal?

This isn’t directly involved with participatory medicine, unless you believe that a responsible patient wants to know the best way to do participatory health, and thus avoid the need for health care. Lower costs and keep your family out of the hospital – good deal, huh?

The best way to do that, of course, is with prevention and good primary care. So you’d think preventive services would be the most highly valued.

Well, they’re not, and a major reason is that there’s been a secretive rate-setting cabal for twenty years, which decides who’ll be paid how much. And those people vote, year after year, to pay primary physicians less, and pay specialists more.  To quote a Wall Street Journal article last fall:

Three times a year, 29 doctors gather around a table in a hotel meeting room. Their job is an unusual one: divvying up billions of Medicare dollars.

The group, convened by the American Medical Association, has no official government standing. Members are mostly selected by medical-specialty trade groups. Anyone who attends its meetings must sign a confidentiality agreement. …

Today the Health Affairs blog has a new item about this, Stifling Primary Care: Why Does CMS Continue To Support The RUC? It starts:

Last October, the Wall Street Journal ran a damning expose about the Relative Value Scale Update Committee (RUC), a secretive, specialist-dominated panel within the American Medical Association (AMA) that, for the past two decades, has been the Centers for Medicare and Medicaid Services’ (CMS’) primary advisor on valuation of medical services. Then, in December, Princeton economist Uwe Reinhardt followed up with a description of the RUC’s mechanics on the New York Times’ Economix blog.

The Health Affairs post is concise and informative; read it. It notes that the American Academy of Family Physicians is reviewing whether to pull out of the RUC, which (the post says) would seriously undermine RUC’s credibility, and perhaps end this.

One more thing to think about, re patient empowerment:

As the Affordable Care Act moves toward providing coverage for the 40 million Americans who don’t have a primary physician, I constantly hear bitching and moaning about how we already don’t have enough doctors to go around.

Well, let’s fix that. Let’s make it more inviting for physicians in training to go into this field, and let’s give more appropriate recognition to those who took it on despite its being a lower-paying field.

Let’s fix that. Raise hell about the RUC.


Posted in: policy issues | reforming hc




7 Responses to “Stifling Primary Care: Why does Medicare/Medicaid Still Support the “RUC” Rate Setting Cabal?”

  1. Ed Yourtee says:

    Thanks for pointing this out, Dave. Just one of many forces conspiring against the primary care supply. A new study in the current JAMA again confirms the relationship between ambulatory primary care and favorable patient outcomes.

    Folks don’t realize the extreme costs of medical school also keeps docs from going into primary care. Those costs have to be repaid, and doctors don’t begin their professional earnings until 7-10 years AFTER their bachelors degree, when most of their peers are buying their second house. Needs to be addressed.

  2. Good reminder about the incredibly corrupting influence of the RUC.

    I believe the story is much worse than how it is presented, in general. The RUC is the perfect tool for Opaque, Inc..

    For those interested in the work product of the RUC do an in-depth check of what RBRVS are and their impact on the total cost of care in the US. Disgusting!

  3. David Harlow says:

    For excellent writing about the RUC, stretching back over several years, see Roy Poses’ blog, Health Care Renewal:

  4. Gary Levin says:

    There are lots of inequalities,between PCPs and specialists. not just $$ .

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