Blog | Monday, June 20, 2011

Time for Medicare to quit ignoring primary care


An article by Brian Klepper and Paul Fischer at Health Affairs has me all fired up. Finally these two health experts are calling it like it is. The Wall Street Journal, New York Times and EverythingHealth have written before about the way primary care is undervalued and underpayed in this country and how it is harming the health and economics of the United States.

A secretive, specialist-dominated panel within the American Medical Association called the RUC has been valuing medical services for decades. They divvy up billions of Medicare and Medicaid dollars and all insurance payers base their reimbursement on these values also. The result has been gross overpayment of procedures and medical specialists and underpayment of doctors who practice primary care in internal medicine, family medicine and pediatrics). These payment inequities have led us to a shortage of these doctors and medical costs skyrocket as a result. As Uwe E. Reinhardt says, "Surely there is something absurd when a nation pays a primary care physician poorly relative to other specialists and then wrings its hands over a shortage of primary care physicians."

Klepper, Fischer and author Kathleen Behan make a bold suggestion. Let's quit complaining about the RUC and their flawed methodologies. Let's quit admiring the problem of financial conflicts of interest and the primary care labor shortage. It's time for the primary care specialty societies, the American Academy of Family Physicians and the American College of Physicians (my addition) to pull out of the RUC. Yes, just quit and do it in a public manner.

There would certainly be a negative public relations backlash when a prestigious specialty society says, "We're mad as hell and not going to take it anymore". The AMA would have to take notice, as would the Centers for Medicare and Medicaid Services. If the American College of Physicians and the American Academy of Pediatrics would also defend its primary care physicians, it would send a strong and powerful message. Primary care has been decimated and the RUC is to blame, pure and simple.

Klepper and Fischer say "We have had two decades of declining reimbursement that has gutted primary care's viability ..." We should all care because every modern nation that exceeds our outcomes for lower cost does so by valuing primary care and supporting it as part of health care policy. If we are really serious about health care reform and bringing costs under control, we first have to build the infrastructure of public health and that is strong, viable primary care for all Americans.

This post originally appeared at Everything Health. Toni Brayer, FACP, is an ACP Internist editorial board member who blogs at EverythingHealth, designed to address the rapid changes in science, medicine, health and healing in the 21st Century.