Under the current system for healthcare reimbursement, the AMA’s relative value updated committee (known as the RUC).  The panel is mostly made up of medical specialists.  This panel establishes what is to be paid by Medicare (CMS).   CMS has pretty much rubber-stamped the recommendations for 2 decades.

It is unfortunate that health care costs are really killing the American economy. Over the past 11 years, the premiums have risen nearly four times as fast as the rest of the economy. Health care costs nearly are about twice what they are in other developed nations have.  The burden on American companies creates a major disadvantage in the global marketplace.†

Other factors are the costs for care that have little or no value – as much as 50%, drugs, laboratory costs, inappropriate procedures, etc.  The total wasted expenditures are as much as $1.5 trillion this year alone.

Experts say the major flaws are

  • the fee-for-service reimbursement policy
  • lack of cost, quality and safety evaluation

Evidence shows that primary care physicians who serve as patient advocates who guide the patient through the entirety of care process cost significantly less.  Current studies demonstrated measurable cost and quality successes.  As a result American companies are enrolling their employees in the use of on-site primary care clinics.

A move is being made toward getting primary care doctors involved to launch a campaign to work on CMS to replace the RUC with an independent panel with more primary care physicians serving on it.  This would move forward better debate and planning for how to deal with fair value and pay for U.S. Health care.

The main problem is that the current reimbursement system pays more to hospitals, specialists, and drug, device and technology firms than is paid to primary care physicians and the former will absolutely resist any changes.  It is interesting that these lobbying interests spent $1.2 billion to congressmen to achieve the status quo or to better effect those programs that will serve them best. So the Davids (250,000 primary care physicians in the U.S.) versus the Goliaths (the big beneficiaries) will not be a lopsided struggle.