The little-known American Medical Association committee that recommends physician pay scales to Medicare’s fee-for-service program today asked the agency to reimburse physicians for coordinating care for their chronically-ill patients. In a letter to administrator Donald Berwick, the Relative Value Scale Update Committee (better known as the RUC) recommended the Center for Medicare and Medicaid Services pay for phone calls, counseling sessions and other services that help their patients wend their way through the complicated health care system.
Good idea, and long overdue. But what I didn’t see in the letter from RUC committee chairwoman Barbara Levy was any reference for how to pay for these new services. How about a reduction in the “relative value” of back surgery or conducting angioplasty on patients complaining of persistent chest pains? These are among the most expensive and overused procedures in medicine, incentivized by the extraordinarily high fees earned by the surgeons who do them. These surgeons often earn two or three times what primary care physicians earn.
Perhaps it’s time for Medicare to adopt the same rule that Congress uses when passing legislation. Any new spending on physician pay must be offset by cuts elsewhere in the Medicare budget. It’s called the “pay-for” rule. President Obama’s “millionaire” tax is his answer to how to pay for the $487 billion jobs package. Republicans on the Hill tried to tag emergency relief to flood victims in the Northeast with a pay-for, something that Congress has never done before when American people are suffering from natural disasters.
A physician “pay-for” rule could become part of the permanent “doc fix” that the AMA is seeking before the end of this year. Congress needs to come up with nearly $300 billion over the next decade simply to hold physician salaries where they are. The permanent fix would set a cap for total physician pay; and allow it to rise over time for inflation. But why not require that CMS adjust payments to the various specialties to meet that cap? Otherwise, in a few years we’ll be right back where we are today: a permanent fix that wasn’t permanent at all, with new services inflating the total tab beyond the cap.
A hard cap with a pay-for rule will give the RUC a real job. Instead of being a body that calls for steadily increasing fees for every specialty, it will have to take up the hard task of fairly divvying up a constrained physician salary pie.
The author, Merrill Goozner, is an award-winning journalist and author of ’The $800 Million Pill: The Truth Behind the Cost of New Drugs’ who writes regularly at Gooznews.com.
By Merrill Goozner
Merrill Goozner is an award-winning journalist and author of "The $800 Million Pill: The Truth Behind the Cost of New Drugs" who writes regularly at Gooznews.com.Visit website | More posts by Author
Pardon me if I seem perplexed about this article and the legislation it's referring to, but I thought that this kind of counseling and care coordination was what nurses (especially geriatric care nurses and case/care managers) have been doing for decades. And, at a much lower cost to whoever is paying the bill than would be approved for a doctor. Nurses have been leading this movement...of coordinationof care (search the 'net for innovative care models, transititional care models, Dr. Mary Naylor, etc. and you will come up with dozens of programs that are doing exactly what the AMA/doc's legislation proposes. Yes...care management and care coordination IS somethign that needs to be done--espeically with the aging population's chronic conditions and dementia--but it's not something that docs should be doing; it's something that, at best, they should be overseeing. And no, I'm not a nurse. I'm a journalist covering health care and geriatrics.
Good news: Making recommendations on “divvying up a constrained physician salary pie” is what the RUC already does. The RUC is a panel of physicians that makes recommendations to Medicare’s decision-makers on how to “divide up the pie” – the set amount of money they receive to pay physicians for the services provided to Medicare patients. The RUC does not make any recommendations on the amount of money spent by the government on the Medicare program. That decision is made by Congress. The recommendations made by the RUC are done within Medicare’s budget neutral process. In fact, when the government was unable to effectively identify misvalued physician services, the RUC took on the task of reviewing and identifying more than 900 potentially overvalued services – a far cry from calling for steadily increasing the values for all physician services. Their recommendations have already led to more than $1.5 billion in Medicare physician payments being redistributed. Those savings allow for increases in other services, or as was recommended in the letter, recognizing new services performed by physicians who treat chronically ill patients.