Why Aren’t Primary Care Physicians More Ticked off about the RUC? An Interview with Brian Klepper

Brandon Glenn

Published 4/30/13 in Medical Economics

If primary care physicians have a bigger enemy than the RUC, Brian Klepper, PhD, hasn’t heard about it.

The American Medical Association’s (AMA) Relative Value Scale Update Committee (RUC) is a 31-physician panel that wields enormous influence with the Centers for Medicare & Medicaid Services (CMS) in setting the relative values of medical procedures, which are then used to determine reimbursement levels. CMS has historically accepted about 90% of the panel’s recommendations.

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Galvanizing Primary Care’s Power: A Call For A New Society

Brian Klepper

Posted 6/25/12 on Medscape’s Care & Cost Blog

The dream of reason did not take power into account – modern medicine is one of those extraordinary works of reason – but medicine is also a world of power.

Paul Starr, The Social Transformation of American Medicine, 1984

How can primary care’s position be reasserted as a policy leader rather than follower? Even though it is a linchpin discipline within America’s health system and its larger economy – a mass of evidence compellingly demonstrates that empowered primary care is associated with better health outcomes and lower costs – primary care has been overwhelmed and outmaneuvered by a health care industry intent on freeing access to lucrative downstream services and revenues. That compromise has produced a cascade of undesirable impacts that reach far beyond health care. Bringing American health care back into homeostasis will require a approach that appreciates and leverages power in ways that are different than in the past.

But primary care also has complicity in its own decline. It has been largely ineffective in communicating and advocating for its value, and in recruiting allies who share its interests. Equally important, it has failed to appreciate and protect primary care’s foundational role in US health care and the larger economy, as well as the advocacy demands of competing in a power-based policy environment.

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There is Only One Issue in America

Steve Van Zandt

Posted 12/10/11 on Huffington Post

I was obsessed with politics in the ’80s. I’ve recovered and I’m feeling much better now thank you.

By the time I realized, as interesting as it was, I’d better stop this stuff and try to earn a living, I had discovered many of our social problems and quality of life issues could be traced to the same political source: our corrupt-by-definition electoral system. The solution to the problem was as easy to discover as the cause: The elimination of all private finance in the electoral process.

I was working doing most of my research in the area of our foreign policy since WWll, whatever fell under the umbrella of international liberation politics, but I examined and analyzed a fair amount of local issues as well.

I wanted to know how things work? Where’s the power? Who’s pulling the strings?

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A Population-Based Care Management Lesson: What Telephonic Disease Management Lacks In Individual Effectiveness Is Made Up By Its Greater Reach

Jaan Sidorov

Posted 11/17/11 on the Disease Management Care Blog

In yesterday’s post on the role of telephonic disease management for obesity, the Disease Management Care Blog pointed out that POWER was a landmark study that demonstrated that remote lifestyle counseling performed as well as traditional face-to-face counseling.

New England Journal of Medicine editorial accompanying thePOWER article points out that there may have been an additional factor that explained the results: patient attendance at the in-person counseling sessions dropped off precipitously as the trial progressed (an average of only 2 out of 24 scheduled visits after the seventh month), while the telephonic approach achieved 16 out of 18 scheduled contacts.

The DMCB agrees and suggests this is an additional virtue of remote telephonic disease management.  While in-person counseling may have more of an individual impact, it does little good if  patients no-show.  In contrast, “high volume” telephonic counseling may have more of a population-based effect, because a lower intensity intervention has greater absolute impact if it’s delivered to morepersons.

NIH scientist Susan Yanovski’s editorial falls short on capitalizing on that insight.  While it grudgingly points out that POWER shows “PCPs can deliver safe and effective weight-loss interventions in primary care settings,” it neglects to mention the two important implications of POWER:

1) non-physician team members acting in collaboration with PCPs are an important resource in the national battle against obesity and

2) offering a variety of communication channels increases reach and gives more patients new and effective options to access anti-obesity programs.