Why Primary Care Needs A New Organization

Paul M. Fischer

First published on 6/15/11 on MedPage Today

A few weeks ago, the Board of the American Academy of Family Physicians (AAFP) announced that, for now, it would continue participating in the Relative Value Scale Update Committee (RUC), the secretive American Medical Association committee that, through a longstanding relationship with the Centers for Medicare and Medicaid Services (CMS), has heavily influenced physician reimbursement.

At nearly the same time, Medicare announced that it will go broke in 2024, a decade sooner than expected and only 13 years away.

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What Cost Controls? Republicans To Seek Multi-Year Doc Fix

Merrill Goozner

First published 5/06/11 in The Fiscal Times

The annual scramble to prevent next year’s scheduled pay cut for doctors who treat Medicare patients kicked off Thursday with physician leaders calling for a five-year program of guaranteed annual raises and a high-ranking Republican calling for another short-term fix.

The issue – known inside the Beltway as “the doc fix” – is the residue of a law enacted by Congress in the late 1990s that sought to limit the growth of Medicare spending. The law limited physician pay increases to same growth as the overall economy, which became known as the sustainable growth rate or SGR. Since health care spending over the last decade grew twice as fast as gross domestic product, implementing the SGR would dramatically shrink physician pay as a share of overall Medicare spending.

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Point-Counterpoint: A Hospitalist and An Internist Argue Relative Value

Brian’s Note: Readers may know that, on this site and on Replace The RUC, I re-published the article below by the Happy Hospitalist, a physician intimate with coding and its craziness. His explanations of the system’s inconsistencies are lucid and compelling, as are his descriptions of how adhering to this system is overwhelmingly burdensome. Those of you who have read it before may want to scroll down to the content that follows and responds to it.

Then, last week, I received a long complaint from an orthopedic surgeon who appeared knowledgeable about coding, and who defended the RUC’s approach. He claimed that, properly understood, specialists make approximately the same as primary care physicians on an hourly basis. I am by no means a coding expert, but I responded that, while his argument may have some merit, the facts remain that specialists have made increasingly more over time than generalists who see many more patients. I thought there was a logical flaw in his approach.

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In the Eyes of Medicare, You’re a 99223


First published 11/26/07 on The Happy Hospitalist.

Want to know how doctors get paid?  What is a 99223?  What does that mean? Well. It means everything. And it means nothing. It is the vast land of numbered codes, the mystery of  CPT medical coding that every physician must grasp, or at least their office staff, in order to get payed for services provided. It is how doctors get paid to remain a viable business of providing health care.  It is called coding.  I’ll repeat simply:  It is how physicians get paid.

As much as I love coding (because I’m good at it, really good at it), it is a ridiculously difficult and arbitrary. So difficult and vague that often times audits by Medicare often result in multiple different opinions by Medicare themselves, by their auditors.

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