A Legal Challenge to American Health Care’s Payment System

Late yesterday afternoon, six primary care physician from Augusta, GA filed suit in a Maryland federal court against HHS Secretary Kathleen Sebelius and CMS Administrator Don Berwick. Here is the press release associated with the filing.

Contact: Melody Collins                                                              FOR IMMEDIATE RELEASE

706-922-8242, mcollins@cpcfp.com

GEORGIA PRIMARY CARE PHYSICIANS SUE MEDICARE AGENCY

Government’s AMA RUC Relationship Illegal, Hurts Primary Care, Wastes Medicare Dollars

Six physicians from the Center for Primary Care in Augusta, GA, have filed suit in a Maryland federal court against HHS Secretary Kathleen Sebelius and CMS Administrator Donald Berwick, charging that the payment system arising from their agencies’ longstanding relationship with the American Medical Associations’ specialist-dominated Relative Value Scale Update Committee (RUC) is illegal, compromising primary care physicians’ abilities to ensure the best care possible, driving up cost and harming their financial interests.

The suit alleges that, for nearly 20 years, HHS and CMS have let the RUC, their primary advisor on physician payment, evade the Federal Advisory Committee Act’s requirements for representation, transparency, and methodological rigor. Kathleen Behan, the physicians’ lead counsel, said, “We’re filing this suit to bring America’s physician payment system into accord with law.” The plaintiffs seek injunctive relief that would freeze the relationship until the agencies comply.

The suit notes that the RUC has systematically overvalued many specialty procedures while undervaluing primary care. CMS has historically accepted more than 90 percent of their recommendations. The resulting higher income for specialist physicians has discouraged medical students from primary care, explaining the US shortage of generalist physicians. Worse, as Medicare reimbursement has dwindled, visit times have shortened while patients’ medical concerns have mushroomed and intensified. Plaintiff Rebecca Talley MD noted, “By favoring procedural over cognitive work, the RUC has made general medicine unappealing to our youngest colleagues, created mistrust between doctors and confused patients about who has their best interests in mind.”

While the suit must show the payment system’s harm to primary care physicians, it also hurts patients, purchasers and the larger American economy. Paul Fischer, MD, who spearheaded the group’s effort, said “Medicare lets a financially-conflicted AMA committee set physician pay, stifling primary care while promoting the overuse of expensive procedures that often provide little value. It threatens affordable care as well as the federal budget. We decided to challenge this.”

An article in The Hill quotes a RUC spokesperson as saying that “any increase in Medicare payments for primary care doctors will hurt specialists.”

The doctors have financed the suit themselves, for the sake of the public interest. Supporters can learn more and contribute to the legal defense fund at Save Primary Care.

About Brian Klepper

Brian Klepper is a health care analyst and the Chief Development Officer of WeCare TLC onsite clinics.
This entry was posted in Market Dynamics, Medical Management, Physicians, Policy/Law/Regulation, Quality, Reform and tagged , , , , , , . Bookmark the permalink.

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