Not surprisingly, the Committee’s payment recommendations have consistently favored specialists at the expense of primary care physicians. More striking, however, is CMS’ rubber stamping of about 90 percent of their suggestions, even though, in their last three service reviews, the RUC urged payment increases six times more often than decreases.
This arrangement has played out well for specialists, but the health system consequences have been catastrophic. One significant result has been a primary care shortage. Specialists now earn, on average, $135,000 a year and $3.5 million over the course of their careers more than their primary care colleagues. The income disparity has driven all but the most idealistic medical students away from primary care.
You can read the entire column here.
7 comments:
I am amazed by your biased lack of insight to the problems of the US health care crisis. Pitting physicians against one another will only worsen the problem. Use your pen to help not harm. Comparing hospital employed doctors to self employed doctors or E&M coding to CPT coding as is implied in your comments is misleading and inflammatory.
Good article, Bob, and oh so true. It is not surprising however, that the RUC behaves in this way. To favor on segment of a community, in this case, specialists over primary care doctors is all part of what DC does best, oiled by cash and influence. Consider a rare idea that none of the alphabet soup of advisory committees ever seem to recognize in their great wisdom. It is called free market economics wherein value and therefore price are arrived at by the the people, not collectivity, but as 300 million individuals, who shop based on perceived value, price and availability. Otherwise, these decisions are made by and for "those that brung 'em."
Sadly the public's respect follows the dollars. If specialists get paid more people think they're the ones that solve their problems, whether they do so efficiently or not.
The ability to see a specialist without a referal is always mentioned in plan benefit documents.
No one will convice the public that less can be as effective as more in health care until the dollars start going to the first line providers.
Oh, yes. Let the free market solve the problems! Since when did the market ever really work in the health care world? While I'm not opposed to policies that would encourage market forces, to expect that somehow the market will fix the distortions in the health care system is to simply spout an ideology in the absence of empirical evidence. The forces that confound free market calculus go way back, beginning with when companies began providing employees with health insurance, thus creating the whole construct of third-party payers.
No doubt you are 100% right about group healh insurance distorting the health insurance market in two ways. The first is health care distortion ala the Third Party system of payments. The second is in the tax subsidy of well over $1 Trillion.
However, there is much evidence now on the books that plans such as HSA's actually lower healthcare spending without any sacrifice in the quality of health care.
If one were to empower individuals to take control over more of their health care dollars would it not follow that what we call the cost of health care would decline?
The financial support of Primary Health Care within our nation's health is only one of its many fundamental problems. Central to these problems is that a "Tragedy of the Commons" has developed over the last 40-50 years. The cost of our nation's health care between 1960 and 1970 represented 6-7% of our nation's gross domestic product. In 2010, the most recent estimate is 17.5%. For the other developed counties of the world, it is most recently 13% or less. The difference amounts to 600 billion dollars. At a minimum, our nation's ability to participate in the world's economy is seriously impaired by the cost of our nation's healthcare. Its inefficiency is the elephant in the closet.
To solve this "Tragedy of the Commons" will not be solved by a spending plan for reform. I would start by consulting Elinor Ostrom who received a Nobel Prize in 2009 in economics. The Nobel Prize was based in part on her book published in 1991 "Governing the Commons."
Paul Nelson, M.D.
Omaha
The AMA is proud to convene the RUC, an expert panel of volunteer physicians who make recommendations on how to value the work and resources involved in patient care. The RUC often recommends increases for primary care services. The fact is that the RUC’s recent recommendations have resulted in $4 billion in annual increased payments for office and hospital visits – the most common services performed by a primary care physician. In fact, the American Association of Family Physicians recently shared with their members information on improvements stemming from the work of the RUC to increase values for primary care services. http://www.aafp.org/online/en/home/publications/news/news-now/practice-management/20101201cptcodesrise.html
The RUC is far from secretive. More than 300 attendees participated in the last RUC meeting and information is publicly available, including at www.ama-assn.org/go/rbrvs. The RUC makes recommendations based on Medicare law and policy, and CMS makes payment decisions. The reality is that no other group exists to undertake this difficult work, and when the government was unable to review overvalued services the RUC added this to its workload - at no cost to taxpayers.
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