Replace the RUC

A few weeks ago, my writing partner David C. Kibbe and I ran an article on Kaiser Health News called “Quit the RUC!“ that has caused some turmoil within the physician community, particularly in DC.

First, it noted that the RUC, the informal specialist-dominated AMA panel, has made recommendations for 20 years about the value of medical procedures within the highly arcane and jiggered Resource-Based Relative Value Scale (RBRVS). As the Wall Street Journal recently reported, CMS (and its predecessor, HCFA) has accepted some 90 percent of its recommendations, apparently almost without question. It shouldn’t surprise anyone that the vast majority of recommendations involve payment increases to specialists that have come at the expense of primary care.

Why The FMA Is Off-Base On Reform

BRIAN KLEPPER and DAVID C. KIBBE

First Published in the Florida Times-Union

At an Orlando meeting last week, Florida Medical Association (FMA) members fumed that their parent, the AMA, isn’t adequately representing Florida’s private practice doctors. After talk of secession and forming a new group, they settled for writing a stern letter urging the AMA to straighten up.

The FMA dustup began with a resolution written by Douglas Stevens MD, a Fort Myers cosmetic surgeon – you can’t make this stuff up – complaining that the AMA’s support for recent reforms was “a severe intrusion in the patient-physician relationship and allows government control over essentially all aspects of medical care.” He wrote that it will “relegate physicians to the role of government employees…and essentially end the profession of medicine as we know it.” A St. Petersburg neurological surgeon, David McKalip, added, “Without (AMA) support, the whole thing (i.e., reform) would have died."

Will Business Force Reform Back To The Drawing Board

BRIAN KLEPPER and DAVID C. KIBBE

Until now, non-health care business has been noticeably absent from the health care reform proceedings , and quiet about the bills' impacts on their management of employee benefits, on cost, and on the larger issues of global competitiveness. Where have the voices been of the powerful business leaders who will pick up much of the tab?

They've finally surfaced, and now we'll see whether they have the will to bring reform back on track. They certainly have the strength. The question is whether this salvo by the business mainstream could force Democrats to reconsider and revise the content and structure of their proposals.

The AMA Wins A Round Against Accountability and Patient Information

BRIAN KLEPPER

On January 30th, a 3-judge DC appeals court overturned a lower court decision that would have forced public release of Medicare physician data. Writing for the majority in a split 2-1 judgment, Circuit Judge Karen LeCraft Henderson declared that
“The requested data does not serve any (freedom-of-information-related) public interest in disclosure. Accordingly, we need not balance the nonexistent public interest against every physician's substantial privacy interest in the Medicare payments he receives.”

But in a strongly worded dissent, Judge Judith Rogers, the third member of the ruling panel, found that the request by the consumer group, Consumer Checkbook, represented “a commanding and important public interest in disclosure of the data.”

Medscape Video: Re-Empowering Primary Care

Can Health Plans Explain Why They Aren't Re-Empowering Primary Care

BRIAN KLEPPER and DAVID C. KIBBE

First published on THCB.

Sometimes a whisper is more powerful than a shout. Here's a cartoon from Modern Medicine that shows a Medical Home counseling session between a primary care physician (PCP), a specialist and the health plan. The PCP looks forlorn, while the specialist and the insurer have their backs turned, fuming. It is perfectly true.

Cognitive Dissonance and HHS' Position on Medicare Physician Data

Just as it launches a new program aimed at allowing local organization access to physician profiling information, HHS has blocked access to that same information by a national consumer group.

Here's a really classical example of a federal regulatory agency holding fast to two opposing ideas at the same time. I wonder what it means?

Last week HHS posted  an interesting notice announcing a new program that recognizes 14 (presumably) forward-thinking health care coalitions of providers, employers, insurers and consumers, which it refers to Chartered Value Exchanges, or CVEs. (Who comes up with these names?!)