Saturday, February 5, 2011

AMA response to "Outing the RUC"

In general, I do not post comments regarding "Comments" posted to my blog. I appreciate them, would encourage you to post them and will reply personally if asked and given an email address, but the nature of a blog does not really encourage dialogue among readers. This is because once you have read a post, you are unlikely to come back and check to see if there are any "comments" posted that you might wish to comment further on.

I am making an exception in this case to call attention to the comment from the American Medical Association.
They indicate that "The entire premise of this column is false." They note that "The RUC often recommends increases for primary care services; RUC recommendations have resulted in $4 billion in annual increased payments for office and hospital visits – the most common services performed by a primary care physician." I note that this is not entirely responsive; while the "office and hospital visits" are the most common services provided by primary care physicians, they are also provided by many subspecialists, and we don't know what % has gone to PCPs vs. subspecialists, nor do they indicate what % of Medicare physician payments $4billion is. The sources of my information are cited; also the data in the graphic showing that the ratio of subspecialists to PCPs is INCREASING, not DECREASING, is the important point. Indeed, the graphic here, from the recently-released 20th report of the Council on Graduate Medical Education (COGME) shows that this definitely affects entry into primary care.
Please add your comments if you wish.

1 comment:

Bob Bowman said...

First of all RUC is RVS Update Committee (Relative Value Scale)

The sum of 4 billion is a drop in the bucket compared to 125 billion for primary care spending a year. The US is doomed to be far short of the care needed for at least 90% of the nation with less than 200 billion for a real primary care delivery system. The US has attempted to graduate more primary care but fails because the amount for primary care support, fails to support sufficient workforce. The evidence is insufficient experienced RN, MD, DO, NP, and PA primary care with departures before, during, and each year after insufficient primary care training (and dysfunctional training as documented by Keirns in Academic Medicine, and primary care training not really focused on primary care or accredited by primary care or funded through primary care - try 70% or more on panels as academic, hospital, and subspecialty).

11 billion more for FQHC was not a bad improvement and was direct to those hurting most - those providing services to Medicaid patients - care which states short-circuit with grossly insufficient primary care reimbursement

27 billion more would have been nicer, but it went to health information technology as compared to direct primary care services support

Current national panels "attempting to help primary care" fail to understand full scope primary care by recommending increases in codes that failed rural family physicians and broad scope internists. These have to be fixed (Graham Center, others) to prevent even more damage. Why have panels that fail to understand primary care where most needed?

Massive misunderstandings are present to the top national panels and top national reports. GAO has primary care increasing and so does HRSA even with IM primary care decreasing from 110,000 to less than 50,000 from 2000 to 2030 with other sources not able to make up this gap, especially for the elderly that are doubling 2010 to 2030.

Then the AMA is on record as opposing shifting to primary care. In studies physicians oppose even a 3% sacrifice to restore primary care spending (which 80% support- Leigh). Which is it, better health care for Americans or pocketbook protection?

Then there is the failure to accomplish any family medicine expansion in 30 years - as Ferrer and others have demonstrated - the one source most needed now and for the next 20 years for the elderly that are doubling, for CHCs, for the lower and middle income people that are increasing in health care coverage, and for the poor and near poor and rural and disadvantaged that are even more left behind by designs shaped by organized medicine, medical education, and health care corporations - for 100 years.

Perhaps the major evidence against the current panels - is the fact that the reimbursement designs fail. Survival of substantial needed services essential to many populations requires bailout and bypass special programs Critical Access for rural hospitals, rural health clinics, FQHCs, and CHCs And this funding also can be shifted to academic and other locations with top concentrations of health spending - rather than arriving where most needed to support primary care services for those most left behind.

A real health design for a nation is the opposite from the US design. A real health design focuses on the health care needs required by nearly all Americans nearly all of the years of their lives in nearly all locations - not highly subspecialized health services needed for a few people for a few years of their lives delivered in a few locations.

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