Friday, May 16, 2008

"An Impending Hurricane of Outrage" About the RUC?

We have posted a number of times, (most recently here, and see links to earlier posts) about the RBRVS Update Committee's (RUC) responsibility for Medicare's relatively poor payments for primary care and other "cognitive" physicians' services, compared to procedures. This imbalance has rippled through all of US health care, affecting how private insurers and managed care organizations reimburse physicians, and generally how the US systems favors procedures over talking, examining, thinking, diagnosing, prognosticating, deciding, and prescribing and super-specialization over generalism and primary care.

The RUC ostensibly is just an advocacy group sponsored by the American Medical Association, yet it seems to be the only source of outside input about physicians' reimbursement used by the US Center for Medicare and Medicaid Services (CMS). Given this influence, it is dismaying that it is secretive, unrepresentative, and unaccountable. Neither its membership nor proceedings are public. It is dominated by proceduralists and sub-specialists. It is unaccountable to US physicians, much less the general public.

We therefore recently commented skeptically about how CMS put the RUC in charge of setting physicians' payments for the patient-centered medical home (PCMH). The PCMH seems to be a newly fashionable concept for reviving primary care. It turns out a lot of other medical and health care bloggers were equally skeptical. In this post on the e-CareManagement Blog, Vince Kuraitis describes physician bloggers as "spewing venom" at the idea of the RUC determining how the PCMH might work. He linked to five blogs other than Health Care Renewal (and the Happy Hospitalist, to whom we linked in the post above), and then noted "you can add me to the list." His final question was, " Are these reactions just a few lone bloggers, or the first whispers of the impending hurricane of outrage? I suspect the latter."

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