Monday, March 07, 2011

Getting Out of Our RUC - "An Open Letter To Primary Care Physicians"

Since 2007, we have been writing about the secretive RUC (RBRVS Update Committee), the private AMA committee that somehow has managed to get effective control over how Medicare pays physicians.  The RUC has been accused of setting up incentives that strongly favor invasive, high technology procedures while disfavoring primary care and other "cognitive medicine."  Despite the central role of (perverse) incentives in raising health care costs while limiting access and degrading quality, there has been surprisingly little discussion about the pivotal role played by the RUC. 

Now there is a movement afoot to replace the RUC.  In a new post on the Care and Cost blog, and the Replace the RUC site, Paul M. Fischer and Brian Klepper urged four approaches:

1. Make the public aware of the RUC’s role and urge the primary care societies to stop “enabling” the RUC through their participation.
2. Recruit experts who can credibly calculate the economic impacts of the RUC’s actions, and who can devise alternative payment methodologies.
3. Demonstrate the unlawfulness of CMS’ (and HCFA’s) two-decades long reliance on the RUC.
4. Develop a collaboration between primary care and non-health care business.

They are also urging three specific actions:
1. Contact your primary care society to demand that they withdraw from the RUC.
2. Broaden awareness of what we’re doing and why by rebroadcasting to your primary care colleagues.
3. Get in touch to help us with resources, relationships or approaches that can strengthen this project.

They have set up an electronic petition that people can use to urge the three major medical societies that represent primary care physicians to quit the RUC.

On Health Care Renewal, we have been trying to make the systemic problems with with the leadership of health care organizations less anechoic in the hopes that greater realization that these problems exist would lead to actions to solve them. The regulatory capture by the RUC of Medicare's payment setting mechanism is one problem that really cries out for a solution. In 2007, I called for "an unbiased re-evaluation of the components of the RBRVS by people who are dedicated to doing it fairly, not benefiting one group of physicians, or the organizations that benefit from the increased use of procedures"; and "an unbiased investigation of what went awry with the process used by Medicare to determine physician payments."  Your heard it here first on Health Care Renewal.  It is nice to now have such distinguished company. 

I urge our readers to consider the actions urged above. 

True health care reform will require a transparent, honest, fair process for governments to decide on how they will pay for physicians' care and other health care services and goods. 

3 comments:

Merrill Goozner said...

Roy,
Do you know when the RUC meets? I presume there is a CMS process for incorporating its decisions into their payment values, which must be adopted through a federal rule-making process. Do you know when that starts each year, which would be open to comment by the public and interested outside groups? Those of us who want to expose this process in order to facilitate change need to follow it closely, and make the public aware of the decision points. You can contact me offline if you have answers to these questions.
Merrill (GoozNews)

Anonymous said...

A recent post on CardioBrief illustrates the problem with the RUC, not only in setting reimbursement, but also as an excuse for excessive medical interventions.

First Aftershocks Continue To Shake Up Western Pennsylvania Cardiology

Posted on March 4, 2011 by Larry Husten

“ Western Pennsylvania continues to react to yesterday’s disclosure by Westmoreland Hospital in Greensburg that it had told 141 patients that their stents were medically unnecessary. Now a spokesperson for a second hospital, Forbes Regional Hospital in Monroeville, said that the hospital planned “a thorough review of the qualifications” of the two cardiologists involved in the case, Ehab Morcos and George Bousamra. They had received temporary privileges at Forbes several weeks ago after resigning from their positions at Westmoreland. The latest development was reported by Luis Fabregas and Andrew Conte in the Pittsburgh Tribune-Review.

Also quoted by the Tribune-Review is ACC spokesperson Amy Murphy, who noted that the college has “called for accreditation of catheterization laboratories and better standards for when to use coronary stents.” Murphy also pointed out that current reimbursement procedures may be partly to blame: ”You’re not paid for the quality of care; you’re paid for the procedure,” she said. “It’s a flawed system, based on the number of procedures. … We do all this quality work, but the way people are paid is in direct contrast to that.”

The issue at hand was the over stenting being performed by doctors at this, and other hospitals. The excuse was reimbursement created this issue. Those reimbursements are set by the RUC.

One does not have to look far to question the testing and therapies patients are pushed into on a daily basis due to reimbursement. How many patients have been harmed by these financial drivers?

Certainly any group with this much impact on our national testing, prescribing, and treatment guidelines should be transparent and answerable to the public.

Steve Lucas

Scot M Silverstein MD said...

I think the "RUC" needs a face for the public.

How about this one?

Ruk, the last of his kind --

-- SS