Posted by Valerie Arkoosh, MD, MPH February 25, 2011 at 9:30 AM
Obscure acronyms clutter health care speak, but one that we should all know more about is the RUC – the Relative Value Scale Update Committee, a panel created by the AMA. As Brian Klepper, PhD, and David Kibbe, MD, MBA, recently wrote in Kaiser Health News, the RUC is “a secretive, 29 person, specialist-dominated panel” that advises CMS on Medicare’s physician reimbursements rates. The RUC’s influence over payment rates is vast, representing a major factor in ever-rising health care costs.
Since 1991, 90% of the RUC’s recommendations have been adopted by Medicare, and those recommendations have urged pay increases six times more often than decreases. Because Medicare is such a large payer in the market, Medicaid and private health plans have typically followed suit, resulting in system-wide cost increases.
According to Klepper and Kibbe, because the RUC is a specialist-dominated panel, payments to specialists have far outpaced those to primary care doctors. Reimbursement rates favor procedures over primary care office visits, leading to lower income for primary care doctors. This has contributed to a primary care shortage as medical students disproportionately choose the more lucrative specialist fields over primary care.
Along with rising payments, Klepper and Kibber also point out that our predominantly fee-for-service payment system is a major contributor to the cost crisis because it encourages greater, and perhaps unnecessary, use of costly specialty services rather than less interventional treatments.
Because there is no serious threat to the RUC and this arrangement for determining physician reimbursement rates, Klepper and Kibbe argue that the primary care representatives serving on the RUC should quit, thereby de-legitimizing it and creating space for a more transparent and effective process. What do you think? Let us know.
For more on the RUC, check out Dr. Klepper’s new website – Replace the RUC.