Primary Care Revolt Against RUC (Relative Value Update Committee)

Follow the money, and you will know why.

Maxim

Congress should restructure the composition of the AMA's Relative Value Update Committee (RUC). Specialists now dominate the committee.

Jim McDermott, MD, House of Representatives, “Harnessing Our Opportunity to Make Primary Care Sustainable, “ New England Journal of Medicine, February 3, 2011

We must pay our generalists on a par with our specialists or they will forever work at a disadvantage, and the system will remain forever tilted towards specialty care.

Fitzhugh Mullan, MD, Big Doctoring in America: Profiles in Primary Care, University of California Press, 2002

A revolt has been brewing out there for at least ten years among primary care physicians. With the looming shortage of primary care generalists, unsustainable specialist-generated costs, and doctors leaving or not entering primary care at accelerating rates, the revolt is about to explode out into the open.

The revolt boils down to discrepancies of pay between primary care doctors and specialists, and the role of the AMA in nominating more specialists than primary candidates to RUC (The Relative Value Update Committee). Medicare, routinely accepts what RUC recommends, and proceeds to sets fees for the codes used to pay doctors.

Here a primary care doctor, Paul M. Fisher, MD, of the Primary Care Center in Augusta, Georgia, expresses his outrage about the matter.

A Family Physician’s Manifesto

Paul M. Fischer, MD

As a third-year medical student in 1977, I joined the American Academy of Family Physicians (AAFP). In those culturally tumultuous years, it was a way to declare my belief that America needed physicians who cared for the whole person, family and community. It was also a declaration that, in choosing the primary care path in a field ripe with tempting medical specialties, money was not my primary goal.

For much of my 33-year membership, I have considered the AAFP to be “my” organization. However, there is a time when one must step back and declare independence from organizations that have lost touch with their members. The AAFP does much that supports my day-to-day life as a busy family doctor, but for 33 years, its leadership has failed to fix the central problem for primary care in America: poor reimbursement.

I deal every day with complicated health problems of complex patients who are insured by companies singularly focused on limiting even the smallest cost. In return for managing these patients, which often
involves critical and life-or-death decisions, I am paid by Medicare 60% less per hour than is a dermatologist, who, for the most part, treats trivial disease that involves no nighttime emergencies and little intellectual challenge.

The AAFP has implicitly supported this payment fiasco through its membership in the RUC, a committee of organizations focused primarily on defending surgical and specialty fees while ignoring the growing challenges and costs of the practice of primary care. Because the RUC advises Medicare on physician reimbursement, the AAFP’s involvement is tacit agreement with a reimbursement plan that undermines the health of primary care and, hence, the health of the country.

In light of the organization’s failure to effectively advocate through the RUC on behalf of its members for crucial change in physician reimbursement, I strongly urge the AAFP to immediately withdraw from the RUC and work to establish an alternative means of impacting Medicare’s physician payment decisions for the good of primary care and American health care.

Richard L. Reece, MD, blogs at Medinnovation and has a website under construction. www.doctorreece.com. He is the author of three recent books, Obama, Doctors, and Health Reform (Iuniverse, 2009), Innovation Driven Health Care (Jones and Bartlett, 2007), and an E-book, Pros and Cons of Accountable Care Organizations (Practice Support Resources, 2011). He works with but does not speak for The Physicians Foundation, a 501C3 organization representing physicians in state medical societies. Opinions expressed in his blogs are his alone. He can be reached at rreece1500@aol.com and 1-860-395-1501.