• Physician payment and the RUC

    A well-referenced KHN column on the specialist-primary care physician Medicare payment gap by Brian Klepper and David C Kibbe was posted last night. It summarizes the now-familiar story about the Relative Value Scale Update Committee (RUC),

    a secretive, 29 person, specialist-dominated panel. Since 1991, the RUC has been the main, if unofficial, adviser on Medicare physician reimbursement – how specific procedures should be valued. […].

    [T]he 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.

    The column includes the following chart.

    I bring all this up by way of additional evidence that an across-the-board cut to Medicare physician fees, the suggestion of which motivated a post earlier this week, does not make sense. The “doc fix” problem is quite deep. I don’t claim to have an answer, but there are many, many reasons we need one.

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    • I have arguing for a while that we should freeze specialty fees for a while and increase PCP fees. Not an ideal long term solution, fixing fee for service might be better (though I have seen what happens when some docs go on salary), but it should be easy to quickly implement.

      Steve