The RUC (Again): Is there a Light at the End of the Tunnel? A Conversation with Brian Klepper

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David Harlow

Posted August 13, 2013 on HealthBlawg

Tunnel of Light TJ Blackwell Flickr CC http://www.flickr.com/photos/tjblackwell/3362987463/

dharlow-headshot-0210-60kb-2Recently, there were a couple of breathless articles about the RUC (Relative Value Scale Update Committee) published in The Washington Post and The Washington Monthly, reporting as news the state of affairs that has prevailed for years in the realm of re-setting the relative values of physician services annually for purposes of the RBRVS — which is at the heart of the Medicare Physician Fee Schedule (MPFS) and which affects physician reimbursement well beyond Medicare, since the RBRVS is used as a touchstone in determining payment levels under commercial payor agreements as well.

I thought this confluence of publications was a good excuse to call up Brian Klepper, who is an expert critic of the RUC, to discuss the latest stories and talk about the prospects for meaningful reform.

Have a listen to our conversation (about 30 minutes long):

Brian Klepper on RUC HealthBlawg Interview with David Harlow 07262013

Brian Klepper – RUC – HealthBlawg

A transcript is appended to this post.

As detailed in our conversation, the RUC is a committee of the American Medical Association, and it operates behind a veil of secrecy. When it issues its annual update recommendations, CMS generally accepts the recommendation, and promulgates the update as a rule: the annual MPFS rule. The RUC is dominated by specialists, so the system tends to overvalue procedures and to undervalue “cognitive” services, or primary care.

Continue reading “The RUC (Again): Is there a Light at the End of the Tunnel? A Conversation with Brian Klepper”

Nothing About Me Without Me: Participatory Medicine, Meaningful Use and the American Hospital Association

David Harlow

Posted 5/6/12 on Health Blawg

Meaningful Use Stage 2 regulations were released in March by CMS and ONC.  Over the past month or so, I’ve been working with other members of the Society for Participatory Medicine (thank you, all) to prepare comments on these regulations from the patient perspective.  Last Friday, we filed two comment letters on the proposed regulations. One letter to the ONC on Meaningful Use Stage 2, and one letter to CMS on Meaningful Use Stage 2. Each letter opens like this:

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Health Insurance Exchange Regulations and the Health Reform Challenge

David Harlow

Posted 3/18/12 on HealthBlawg

The federal Health Insurance Exchange regulations were released in final form last week.  (See Timothy Jost’s précis on the Health Affairs blog and HHS presser.)

I had the opportunity to hear Pennsylvania Insurance Commissioner Michael Consedine speak in Philadelphia about his state’s progress towards building an exchange the very next day (I was speaking later on the program). Pennsylvania is one of the 26 states challenging the federal health reform law (and even has a state constitutional amendment afoot that would bar implementation of the individual mandate in PA), but that hasn’t stopped the Keystone State from spending a $1 million planning grant and getting a $33.8 million implementation grant to kick their state health insurance exchange into high gear. (Nothing like playing both sides, eh?)

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Data Breach: How Much Will One Cost You?

David Harlow

Posted 3/06/12 on Health Blawg

MP900440914The going rate for a compromised medical record seems to be $1000 (well, at least that’s the asking price) as seen in papers filed in the eleven class action lawsuits against Sutter Health following the theft of a desktop computer last fall.  The computer contained unencrypted protected health information on about 4.24 million members.  The eleven class action suits are likely to be consolidated for ease of handling by the courts.

For an outfit whose most recently reported year-end financials show just under $900 million in income on just over $9 billion in revenue, a $4.24 billion claim certainly qualifies as a big deal.  The data breach claims against Sutter Health were filed last year following its self-reporting of the computer theft, and are in the news again due to the potential consolidation.

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Health Care Social Media – How to Engage Online Without Getting into Trouble (Part II)

David Harlow

Posted 1/05/12 on HealthBlawg

I have been asked to write up some of the core takeaways from the health care social media presentations I have been giving recently, so I am sharing a version of this narrative on HealthBlawg, in two parts.  You may wish to begin with Part I

Professional responsibility and malpractice liability

The American Medical Association has promulgated a social media policy; so has theVeterans Administration.  The two represent very different approaches.  The AMA essentially advocates proceeding with caution, and being cognizant of the damage that one’s own social media activities – and one’s colleagues’ – may do to the profession.  The VA, on the other hand, is out in front on this issue – just as it was with electronic health records – encouraging the use of social media tools to disseminate information and engage patients and caregivers in productive dialogue likely to improve overall wellbeing and health care outcomes.

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Me Too! It’s Not Fair! The Tragedy of the Commons in the Health Care Marketplace

David Harlow

Posted 1/4/12 on HealthBlawg

There are at least two conversations going on in the health care marketplace today, each focused on one of two key questions. One is: How can we achieve the Triple Aim? The other is: Why do they get to do that?  (It’s not fair! I want more!)

Until we stop asking the second question, we can’t answer the first question. Why? Because all too often the answer to the second question is the equivalent of: It’s OK, Timmy, I’ll buy you TWO lollipops; pick whichever ones you want.

It’s the tragedy of the commons, transposed to the health care marketplace.

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Health Care Social Media – How to Engage Online Without Getting into Trouble (Part I)

David Harlow

Posted 1/03/11 on HealthBlawg

I have been asked recently to write up some of the core takeaways from the health care social media presentations I have been giving recently, so I am sharing a version of this narrative in two parts.  Check back soon for Part II

Introduction

“Why do you rob banks?”

“That’s where the money is.”

The legendary bank robber Willie Sutton, when asked, gave this straightforward response explaining his motivation.  A similar motivation may be ascribed to the early adopters among health care providers who have established beachheads on various social media properties on line.  Why be active in on line social networks?  That’s where the people are: patients, caregivers, potential collaborators and referral sources, like many, many other people, are using social media more and more.  Facebook has become nearly ubiquitous, and its user base is growing not only among the younger set, but also among the older set, who are signing up so they can see pictures of their grandkids.  In today’s wired society, on line social networking is the new word of mouth.  Word-of-mouth referrals, personal recommendations, have always been prized; we have simply moved many of those conversations on line.

Continue reading “Health Care Social Media – How to Engage Online Without Getting into Trouble (Part I)”