Three times a year, 29 doctors gather around a table in a hotel meeting room. Their job is an unusual one: divvying up billions of Medicare dollars.
The group, convened by the American Medical Association, has no official government standing. Members are mostly selected by medical-specialty trade groups. Anyone who attends its meetings must sign a confidentiality agreement.
Yet the influence of the secretive panel, known as the Relative Value Scale Update Committee, is enormous. The Centers for Medicare and Medicaid Services, which oversee Medicare, typically follow at least 90% of its recommendations in figuring out how much to pay doctors for their work. Medicare spends over $60 billion a year on doctors and other practitioners. Many private insurers and Medicaid programs also use the federal system in creating their own fee schedules.
The RUC, as it is known, has stoked a debate over whether doctors have too much control over the flow of taxpayer dollars in the $500 billion Medicare program. Its critics fault the committee for contributing to a system that spends too much money on sophisticated procedures, while shorting the type of nuts-and-bolts primary care that could keep patients healthier from the start—and save money.
“It’s indefensible,” says Tom Scully, a former administrator of the Medicare and Medicaid agency who is now a lawyer in private practice. “It’s not healthy to have the interested party essentially driving the decision-making process.”
It’s nice to see the WSJ actually paying attention to the real problems in healthcare. I wrote about the RUC in Fast Company about a year ago:
Imagine there is a committee of politicians made up of 24 republicans and 5 democrats. Their job is to decide a politician’s salary—for democrats and republicans—and decisions are made by majority rule. Which party do you think would have the highest salary?
Much like American politics, doctors have a two-party system. It’s the Primary Care Party versus the Specialist Party. For the past 20 years, the specialists have been pummeling the primary cares.
At the tip of this convoluted payment pyramid lies the RUC, composed of 29 physicians, each representing the 29 specialties. Five of them are primary care doctors. Majority rules. It is the reason our nation’s doctors practice quantity medicine, not quality medicine.
Hey Obama…wouldn’t it have made more sense in your “health reform” to disband the RUC and rebuild it with 20 primary care docs and 9 specialists? That’s how we should use healthcare in America. Unfortunately, in our system, supply creates demand.