Anti-RUC Suit Challenges Process for Setting Doc Pay Scales

Merrill Goozner

Posted 10/25/11 on Gooz News 

Whither CMS? That’s the issue raised by Brian Klepper and David Kibbe in their post on the Health Affairs website this morning. The Center for Medicare and Medicaid Services faces a November deadline for answering a complaint by six Georgia physicians that claims the American Medical Association’s Relative Value Scale Update Committee (RUC) violates the Federal Advisory Committee Act. The RUC periodically sends recommendations to CMS on how it should reimburse different physician services. As Klepper and Kibbe point out, this specialist-dominated committee, after what are the medical equivalent the early 20th century factory efficiency studies conducted by Frederick Winslow Taylor, decides that the value of cataract surgery, for instance, is 12.5 times the value of a primary care office visit.

Continue reading “Anti-RUC Suit Challenges Process for Setting Doc Pay Scales”

CMS’ Opportunity: A Lawsuit Offers A Chance To Reform Physician Payment

Brian Klepper and David C. Kibbe

Posted 10/25/11 on the Health Affairs Blog

By mid-November, the Department of Health and Human Services (HHS) and the Centers for Medicare and Medicaid Services (CMS) must respond to the legal complaint filed in a Maryland federal court by six Augusta, Georgia family physicians.

These doctors are not asking for money, but for relief from the negative effects brought about by CMS’ twenty year reliance on the American Medical Association’s Relative Value Scale Update Committee (RUC) for valuing doctors’ work. They are asking CMS to enforce the Federal Advisory Committee Act(FACA), which requires that regulatory agencies shield themselves from undue special interest influence. In the process, they are asking CMS to rethink Medicare’s approach to physician payment, with a mind toward recognizing and valuing primary care’s ability to treat the whole patient within a larger system of care. They are asking CMS to develop payment policy that supports the needs of patients over those of professional groups.

Continue reading “CMS’ Opportunity: A Lawsuit Offers A Chance To Reform Physician Payment”

Happy Birthday, Dr. Berwick!

Patricia Salber

First posted 9/14/11 on The Doctor Weighs In

Dr. Don Berwick, head of CMS, just turned 65.  He has already turned in his paperwork to get his Medicare coverage.  This is fantastic.  The head of CMS will now receive benefits from the health insurance program that he oversees.

Of course, he is still working, so he still has his employer-sponsored benefits.  But an article on NPR.org indicates he may only sign up for Part A (hospital coverage) to supplement his existing health plan.  Because he doesn’t need to sign up for Part B (doctors and other non-hospital services) yet, he won’t have to worry about paying a means-tested monthly premium.

Continue reading “Happy Birthday, Dr. Berwick!”

The Donald Berwick Predicament

Dr. Donald Berwick runs the Centers for Medicare & Medicaid Services. He now serves under a recess appointment that will expire at the end of this year. And, although the president could take the politically risky step of extending his tenure with another recess appointment, officially naming him to run the agency for the long haul would require Senate confirmation. News reports suggest that this won’t happen. Berwick may not even receive a hearing.

We can’t evaluate the backstage politics, but one thing is certain. Both Democrats and Republicans should be dismayed at the sight of a partisan campaign driving yet another distinguished figure out of American government.

Continue reading “The Donald Berwick Predicament”