AMA's RUC operating on dollars

October 28, 2010 1:37 PM

Shadofax at MovingMeat has an interesting writeup about two WSJ articles on the AMA's RUC and warring specialities.

'Dr. Levy says the committee is an expert panel, not meant to be representative, adding: "The outcomes are independent of who's sitting at the table from one specialty or another."'

I believe is where one would feign a coughing spell and blurt "bullshit!" into your hand.

It seems that each person on the panel brings its own interests to the table pitting "specialty against specialty and surgeons against primary care," as well as arcane rules that encourage costs to only go up.

posted by cftarnas (6 comments total)

I forgot to add (doh!) that the RUC is, to quote the WSJ, the "Physician Panel Prescribes the Fees Paid by Medicare".
posted by cftarnas at 1:47 PM on October 28, 2010

There's an inevitable tension. You'd like to incentivize doctors who can do Hard Things to work hard and be able to do them, which makes them Expensive Things. But you don't want MDs preferentially doing Expensive Things which pay better when Less Hard Thing would work, or systematically becoming unnecessary specialists.

The system we ended up with is kinda nuts, and it may be preferable for congress to tip the scales in favor of effective, simple things like actually talking to patients.
posted by a robot made out of meat at 2:06 PM on October 28, 2010

the idea that government policy can be set by private interest groups fighting for money doesn't make a whole lot of sense... but then I think this fight in particular obscures the larger story which is that doctors, just like lawyers, are going to get squeezed, as medicare cuts are used to 'bend the curve' and the even bigger fish: pharmaceutical corps., hmo's, private hospitals and insurers fight to gobble up the big chunks of the pie. so the surgeons better enjoy those inflated medicare fees now: it's never going to get any better for them.
posted by ennui.bz at 2:19 PM on October 28, 2010

I would have missed these, as I'm not a regular reader of the WSJ, and they are quite interesting. Thanks, cftarnas!
posted by iminurmefi at 2:48 PM on October 28, 2010

As ugly as all of the politicking at the RUC is, I think the rot in Medicare Physician Fee Schedule reimbursement goes much deeper. Reimbursing doctors for care on a per-CPT basis misaligns incentives at a fundamental level, shifting resources away from the management of chronic conditions towards expensive interventions once the chronic conditions have been allowed to reach an acute crisis.

The over-representation of specialists over primary care doctors on the RUC and the poor reimbursement for evaluation and management services is just the icing on the cake, because the whole way the CPT-based fee-for-service system determines what services are reimbursed separately already devalues case management compared to acute care. Also, while private insurers don't always base their physician reimbursement rates directly on the Relative Value Units that the RUC determines, they do tend to follow Medicare's lead in reimbursing at the CPT level, and thus using the same perverse incentives.

There are some interesting pilot programs that were funded as part of the recent health care reform package, such as the Accountable Care Organization model, but ultimately I think they're just dropping more levels of complexity on top of fee-for-service. A successful system will need to look more like the Diagnosis-Related Group system that Medicare (and again, many private insurers following CMS's lead) use to reimburse hospitals for inpatient stays.
posted by strangely stunted trees at 7:07 PM on October 28, 2010

Metafilter: where one would feign a coughing spell and blurt "bullshit!" into your hand.

Sorry, I couldn't escape its tractor beam.
posted by wenestvedt at 7:39 AM on October 29, 2010