Replace The RUC

A few weeks ago, my writing partner David C. Kibbe and I ran an article on Kaiser Health News called “Quit the RUC!“ that has caused some turmoil within the physician community, particularly in DC.

First, it noted that the RUC, the informal specialist-dominated AMA panel, has made recommendations for 20 years about the value of medical procedures within the highly arcane and jiggered Resource-Based Relative Value Scale (RBRVS). As the Wall Street Journal recently reported, CMS (and its predecessor, HCFA) has accepted some 90 percent of its recommendations, apparently almost without question. It shouldn’t surprise anyone that the vast majority of recommendations involve payment increases to specialists that have come at the expense of primary care.

This combination – a highly conflicted advisory panel making methodologically questionable recommendations about payment to a blithely accepting regulatory agency – is at the heart of the American health care cost crisis and the greatest reason why the American economy is literally being bankrupted by its health care costs. This year alone, we’ll spend about $1.3 trillion on health care products and services that provide no value. This is two-thirds again more than we’ll spend over the next decade on the economic stimulus package.

David and I argued that the RUC’s outrageous behavior has been “enabled” by the ongoing participation of the primary care medical societies – the American Academy of Family Physicians (AAFP), the American College of Physicians (ACP), the American Academy of Pediatricians (AAP) and the American Osteopathic Association (AOA) – whose members and whose members’ patients have been increasingly compromised – by poor primary care reimbursement, by poor quality of care systemically and by a system that favors complexity and expense – by the RUC’s actions. We called on the primary care societies to “loudly and visibly” abandon the RUC, and by doing so de-legitimize and shine a bright light on the process. We urge the RUC’s replacement by a new panel that is more independent and balanced, and less conflicted. And we advocate for the development of an alternative payment system to RBRVS that appreciates complexity but also measurable value.

I have been working on this project with Paul Fischer, MD, a family physician in Augusta, GA who became nationally prominent for his early work against tobacco companies. I’ve known Paul for several years, and was immediately impressed by his passion about “the death of primary care.” Paul and I have developed a modest Web site, Replace The RUC, that provides credible content about the RUC and RBRVS, as well as prepared letters that primary care physicians who agree with our position can send to their societies.

We hope you’ll visit the site and, if you believe this is useful and important, pass it along to all colleagues who might be in our camp. This is the wonderful power of the Web, and we should use it to advantage.

One last thought. There will be charges that this is about getting more money for primary care. It is, but that is the least of the goals. The real goal is to wring a hefty portion of the immense waste out of America’s health care system by re-empowering primary care.

It is impossible to overstate how important this is for the future of our country. To our mind, it should be something that all Americans, Republicans, Democrats and Independents, can agree on.

Brian Klepper, PhD, is a health care analyst and Chief Development Officer of WeCare TLC, an onsite clinic firm.

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5 replies »

  1. There are only three ways to fix health care: we can spend more, ration or innovate; and the place to start innovating is the payment system. With the average case running 9 interventions across perhaps 6 health professionals linked only by referral patterns we can expect no outcome other than more transactions…regardless of the transparency of their price or the good intentions of their purveyors. Follow this thinking further at http://tinyurl.com/48q86uq

  2. We need transparency! It should be available on the internet the cost per patient per year for every physician who is recieving public money ie my tax dollars. Neither the public nor those of us who are providers know clearly whether we are dealing with a Mercedes or a Kia dealership when we seek an health care services. We need to know who are doing 20 stents a day or endoscopies every 6 months or always report findings as inconclusive test needs to be repeated. We need to know how many MRIs per patient our doctor usually orders!

  3. I agree with Dr. Klepper. An important topic that virtually no one however outside of the few who take in interest in the mechanics of physician payment has the slightest clue about. Certainly among almost all USA Congress members – at least a few members likely have a full knowledge of the RUC role and its side-effects – and likely no one among the USA public.