To people who follow the issue of health care costs, it is not news that a secretive committee of doctors plays a major role in dictating what doctors get paid. The Relative Value Update Committee, more commonly referred to as the “RUC,” is often blamed for allocating less of the payment pie to primary care doctors and pediatricians who serve on the front lines of health care than to specialized dermatologists or cardiologists.
Still, the Washington Post’s special report about the American Medical Association panel that sets physician payments is a must-read. Using Florida data and specific physician practices as examples, reporters Peter Whoriskey and Dan Keating explain how the committee routinely overestimates how much physician time is required for many procedures, resulting in skyrocketing payments for some specialists over the past decade. An excerpt:
If the AMA time estimates are correct, then 41 percent of gastroenterologists, 23 percent of ophthalmologists and 17 percent of orthopedic surgeons were typically performing 12 hours or more of procedures in a day, which is longer than the typical outpatient surgery center is open, The Post found in the Florida data.
Additionally, if the AMA estimates are correct, more than 3 percent of ophthalmologists and internists and more than 2 percent of orthopedic surgeons are squeezing more than 24 hours of procedures into a single day.
Harvard researchers created the point-based system used to determine payment for doctors’ time. The government later handed responsibility of updating that system off to the AMA, the largest doctor lobbying group, which offered to handle the task for free.
William Hsiao, a Harvard School of Public Health economist who helped to craft the original design, told the Post that the current value system “seems to be distorted” and has been made “highly political.”
Jay Hancock, a senior correspondent at Kaiser Health News, captured it perfectly on Twitter this morning:
Also check out the Post’s video, where Dr. Barbara Levy, RUC chairwoman, defends the group’s practice and its policy for keeping much of the proceedings from public view as a means, she said, of limiting lobbying pressure on members.