Most of the posts I do here have a take-home message tailored to the rollout of the health law: here’s something going on that you can take and write about in your community. So initially I didn’t write about three very good pieces about fee-setting for physician payments. But after thinking about it some more, I decided to draw them to your attention. They may not be all that easy to localize, but they do explain a lot about how doctors are paid, why specialists get so much more than generalists, and why the system is so broken. They are worth your time.
All three articles focus on something called RUC (rhymes with truck) – Relative Value Scale Update Committee, which is run by the American Medical Association and makes recommendations (almost all of which are accepted because there isn’t really a good alternative system) to Medicare about prices of specific physician services. The RUC is dominated by specialists, not primary care physicians, and it favors high-intensity procedures over cognitive medicine. The prices are set based on both the time and the complexity of a physician service. Putting in a stent has higher value than having a good long talk with a cardiac patient about diet, exercise and lifestyle, to come up with one simple example. Continue reading