Sure is the Specialist and the AMA by in large... There are a few docs who share a practice and point of view who have finally found a way to take the AMA and CMS to court over the inherent bias of the RUC commitee which sets the fees... I need to get home but google it and you'll find a ton of stuff on this.
Basically the AMA's RUC which at best should petition and advise the gov't has its "suggestions" approved at a rate of about 94-96% which is incredibly biased towards procedures and surgery. The RUC itself is a 27 chair commitee with only 4 docs on it representing the primaries with all the other chairs seated by you guessed it the entire rest of the better paid, for the most part procedure based specialties.... Of course they'll give us 10-20% on their obligitory Office Visits in exchange for a similar increase in their expensive knock out a batch each day procedures and surgeries... 10% of $100 is a heck of a lot less than 10% of $1,000 bucks now wouldn't ya say????
This is a board that is essence has become a governmental regulating and policy setting agency that meets in the dark, we the public in general have NO Access to their records or meetings, no means of addressing them, lobbying them, meeting with them, holding hearings, being part of such hearings, no less any means of holding them directly, even indirectly accountable....
The RUC in these guys and many other very knowledgeable people's opinions (mine too for the most part) is that it may be the one most forceful and influencial power that has brought American healthcare to the brink of destruction and doom. It has set up the stage for our Way Too Many Specialists and not nearly enough preventive and pro-active primary care, with costly referals and overwhelmed hurried, no influence primaries.... And we all know that this same Fee Schedule is used about 95% of the time to then set the standards and fees brought forth and forced upon us by the insurance industry as well...
It amazes me that the insurance industry has gone along with this so blindly as opposed to doing what would be in their own best interest as to pay Primaries and help them be viable survive flurrish and by using more and helping to employee and get more primaries into such residencies increase their numbers keep the ER visits and referals Down enough to actually save them some serious cash.... all while paying those of us on the primary care side something closer to what we're really worth both in terms of health and improved outcomes as well as in long term savings....
Out of all the healthcare dollars we spend primary care makes up only %5 of all of those dollars consumed.... I forget what specialty care is but I'm thinking about 7-10% because I swear the number for all doctors paid was somewhere around 12% or more but not far from there, so clearly docs in general are NOT the problem like supposedly Labor is the largest costs in Most Industries... But not when it comes to docs themselves....
And never forget that the insurance carriers themselves who really are a Zero Sum Game, NO real Measureable ROI whatsoever.... Increase the costs to us and many others too with Prior Auths and worsened outcomes, deaths, really measureable deaths from denial and lack of access to healthcare..... Add some of the most costs to our consumptions of healthcare spending at about at Least 25% and I seem to remember at least some years ago, some more progressive orgs had them at perhaps as as high as 33% of money spent... and we all know that most countries and our own once you stop monkeying around like they do, can bring those cost down to anywhere from between 5% and 8% of all monies spent.... Gee doesn't that sound like what Docs actually cost???? What if we fired those bozos finally and increased primary care spending and fees by about 50 to 100% and watch the access increase thru the roof, more and more docs would choose the field, less care would be divided, less expensive referrals, less expensive ER, Prompt Care and other kinds of no continuity and preventive progressive positive care.... and Docs would be somewhat happy and positive about their profession and their jobs again leading to actual measureable increases in positive outcomes.... Burnt out docs delivery crumby care and that is a fact, but that is not their fault, it is the systems lead by the carriers and the AMA's RUC.... F'ck the RUC I say....
Paul
This illustrates some of the inequities in the current system. The entire RVU system was designed around procedures. My take is that it is specialist driven, since specialists are the ones generally doing procedures. Of course, I am biased, since I am a PCP.
We get the health care we pay for. Lots of people in specialty care, not enough in primary care and twice as much money going toward specialty vs primary care.
Another reason I love the AMA.
