As the post above notes, yesterday a law suit was filed by 6 Augusta, GA primary care physicians against the actions of CMS and the AMA’s RUC. On this blog and elsewhere over the past 8 months, I have written about the dramatic inequities in American health care payment, and how that has played to the favor of special interests but against the public interest.
Even though news about the filing just trickled out last night, several articles about it showed up immediately. The most provocative – and telling – was a response from a RUC spokesperson that said, “any increase in Medicare payments for primary care doctors will hurt specialists.”
Now, this wasn’t a direct quote, and it wasn’t attributed to an individual, but the sentiment is clear. The RUC, a committee of the AMA, represents the economic interest of specialists. Even though the data are clear that more primary care results in better care and lower costs, and that the current system produces an excess of specialty services, the RUC sees this as a war between primary care and specialty care.
It is true that, in the current system, payment is a zero sum enterprise. If the primary care physicians are paid more, specialists will make less. The converse is also true. For two decades, specialists have made more and more, largely at the expense of primary care physicians.
But let me remind both sides that, as much as I’m rooting for the primary care physicians, the real victims in this debacle have been patients, who have been pawns, often getting either sub-standard care or excessive services, and purchasers, who have footed the bill at twice the rate of purchasers in other developed nations.
The AMA’s RUC has stated whose interests they represent. Now patients, business leaders and, most importantly, CMS should decide how payment policy should work as we go forward. We know the right answer. We can only wait to see how it plays out.
Care And Cost 
Great post – and insight. Should be required reading for all in the HCReform debate. Moving from volume to value will take years of litigation – and while the individual mandate maybe the most visible currently – this helps to highlight some of the other challenges that are equally important.
“The AMA’s RUC has stated whose interests they represent. Now patients, business leaders and, most importantly, CMS should decide how payment policy should work as we go forward. We know the right answer. We can only wait to see how it plays out.”
Excuse me but you left out primary physicians in how this should play out!
Why should a bureaucrat from CMS or a business leader decide how to pay physicians when they are not even remotely involved in the exam room when a patient visits a doctor?
I don’t want to hear any more of, “Well that’s the way it has been so just deal with it!”
Just today I had a married couple come into my office. They are unisured, by choice! They make a financial decision about whether to purchase insurance. They came to my office to discuss whether they should purchase insurance as they want some preventive testing. They are not worried about catastrophic health costs at this time.
The wife wanted a mammogram, ultrasound, PAP test and gyn exam.
The husband wanted a screening colonoscopy.
i checked local radiology group for cash pricing and all the above tests could be purchased direct for about the cost of one months insurance premium.
In effect, the patient came to me asking for prevention advice and I found a direct payment price cheaper than insurance.
So why go through the bureaucracy of CMS, business leaders, lobbyists and the rest of the b.s. that increases the cost of care?
It makes no sense, and I get tired of hearing “experts” tell people what to do!