I am starting to believe that the distortions of physician reimbursement orchestrated behind the scenes by the shadowy RUC are one of the main reasons US health care is in such a mess. We had posted about the RUC, based on some important articles published this year that first brought its machinations to light (1,2,3) here and here.
A new article just appeared in JAMA on the topic(4) by the perspicacious Dr John Goodson, which provided a focus for what was really a Medical Rant:
The story of the RUC often reminds me of conspiracy theories. They (we never really know who they are) determine the fate of the world (or at least the economy). The RUC has disproportionate power and has apparently taken a reasonable idea (RBRVS) and corrupted it. If you want to know who to really blame, it is the RUC. I blame the AMA for developing a committee which does not represent the interest of overall health care, but rather the interests of subspecialties.References:
I do believe that the RUC has done more to negatively impact outpatient continuity, chronic care than any single entity.
This issue deserves more attention. We must expose this problem and make it reach the national conscious. I fear that it is important but a bit obtuse. I cannot imagine a sound bite approach to the evil the RUC has wrought.
1. Bodenheimer T, Berenson RA, Rudolf P. The primary care-specialty income gap: why it matters. Ann Intern Med 2007; 146: 301-306. (link here)
2. Maxwell S, Zukcerman S, Berenson RA. Use of physicians' services under Medicare's resource-based payment system. N Engl J Med 2007; 356: 1853-1861. (link here)
3. Newhouse JP. Medicare spending on physicians - no easy fix in sight. N Engl J Med 2007; 356: 1883-1884. (link here)
4. Goodson JD. Unintended consequences of Resource-Based Relative Value Scale reimbursement. JAMA 2007; 298(19):2308-2310. (link here.)