Secondly, I think it’s ridiculous for you to compare an internist’s intervention versus a surgical intervention. The amount of risk/adverse reaction/patient aggravation you take on is infinitely more than starting someone on an oral hypoglycemic or hypertensive medication.

I would like to see them drop medicare reimbursement to appease primary care specialists, you’ll see so many surgeons pull out of medicare it’ll make your head spin. Have you tried to get in to see and orthopaedic surgeon, we are cranking our practices as much as possible and still it’ll take 4-6 weeks to get in to see one. Just dump another 30 million insured patients into the pot and see what happens to medicare (the lowest payor)

Huh? This must be a joke.

The AMA has made sure that the RUC membership includes a tiny minority of primary care/ generalist physicians, and a minority of “cognitive” physicians. How should they argue, when they know they can be grossly out-voted?

Furthermore, the AMA has apparently tried to keep the involvement of the RUC in determining RBRVS reimbursement rates as obscure as it can. Since I suspect until recently few generalists/ primary care physicians even knew what the RUC was and what it did, they did not have much opportunity to try to push for better arguments on their behalf.

Finally, the AMA has kept the names of RUC members and the proceedings of the RUC secret, so generalists/ primary care physicians who wanted a better argument to be made for them on that committee would not have known to whom they should talk about this.

The notion that the fees paid by a government agency, CMS, to all physicians are fixed by this inaccessible, obscure committee, run in secret, as the AMA’s private “advocacy” group, without public input, is scandalous. It deserves federal investigation. And if Medicare is going to fix physicians’ fees, the public deserves a transparent and accountable process for doing so.

See our posts on Health Care Renewal about the RUC, most recently here:
http://hcrenewal.blogspot.com/2008/07/can-we-fix-medicare-while-pretending.html
with links backwards.

The extra two years of training an orthopaedic surgeon completes compared with an internist can not account for the hundreds of thousands of dollars more they make in procedural interventions.

Should they make more? Of course. Should they make more at the expense of comprehensive care? No. But they do because the value placed on their work far exceeds the intrinsic value they bring to the medical world in extra training and time.

the RVU/RUC is a scam. It is a scam perpetrated by a secrete society of specialists hell bent on controlling their own gravy train at the expense of a devalued system of cognitive care.

And for that we get a comprehensive care system in collapse. Which will literally increase the work for these specialists and their cash flow, which will perpetuate the declining payment for front line docs. It is in a way, the perfect system to create worse health, not better.

If you want to save the back bone of American Health and create cheaper care with more access, you will have to get comprehensive care out of the RVU fiasco. Value it by paying top dollar for it. That cannot be done in the specialist controlled RUC. It is an impossible.

Payments and better conditions for comprehensive primary care physicians needs to rise because they are of extreme value to society. Every successful (better quality, access, outcomes, lower costs) health care system in the world is based on strong primary care. Only in the U.S. is it so devalued and we are breaking the bank. It is the value equation that says primary care needs to be reinforced. If we had true market forces happening without interference it would have already happened. It is happening in a bizarre way with primary care doctors going into concierge medicine and dropping all insurance. That works fora tiny part of the population and a few of the physicians but it is no way to run a country’s health.

Double the medicare rates for primary care and the shortage would begin to be fixed in 4 years. That won’t happen because there is no will but that is all it would take.

The value placed on cognitive based encounters, on a strictly time based assessment, when compared to procedural interventions can not be explained by any rational thought on the current RVU system. We have procedures that are valued 2, 3, 5, 10 times more from a physician work RVU component alone, the part that is supposed to take into account the extra training and time. And that doesn’t even include the bloated practice expense structure in the pe RVU payment structure as well. It is irrational. And because it is irrational, it is not sustainable. Proof positive is the 2% of medical students entering comprehensive care BECAUSE of the failed payment policies of the Medicare National Bank.

How much a comprehensive care doc makes should not be determined by how many xrays are ordered or how many heart caths are done or how many elective knee surgeries are done.

Keep up with yearly adjustments until that happens.

Even an orthopod can understand it.

(sorry, couldn’t resist)

And frankly, if you are “really not interested in how much you get for one” code, then quit complaining that your reimbursement for E/M codes isn’t high enough. After all, “sometimes payment decreases because the time necessary” decreases – heck, just do it faster! /sarcasm off

The point I was trying to make is that pitting one group of physicians against another is a losing game.

But let’s cut to the chase. How much should I be allowed to make? What if I exceed your target?