Better Health: Smart Health Commentary Better Health (TM): smart health commentary

Article Comments (1)

Primary Care Is Undervalued: What Should Be Done?

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 blog post was originally published at ACP Internist*


You may also like these posts

Read comments »


One Response to “Primary Care Is Undervalued: What Should Be Done?”

  1. The Medical Contrarian says:

    Yes the RUC is evil. Yes, a very public declaration might make some feel better about themselves. What then? The RUC is on the way out to be replaced by the IPAB, not likely to be any better at fixing prices. We will replace one political price fixing entity with another and the winners will be those who play the political game the best.

Return to article »

Latest Interviews

How To Be A Successful Patient: Young Doctors Offer Some Advice

I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…

Read more »

How To Make Inpatient Medical Practice Fun Again: Try Locum Tenens Work

It s no secret that most physicians are unhappy with the way things are going in healthcare. Surveys report high levels of job dissatisfaction burn out and even suicide. In fact some believe that up to a third of the US physician work force is planning to leave the profession…

Read more »

See all interviews »

Latest Cartoon

See all cartoons »

Latest Book Reviews

The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

Read more »

Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

Read more »

Unaccountable: A Book About The Underbelly Of Hospital Care

I met Dr. Marty Makary over lunch at Founding Farmers restaurant in DC about three years ago. We had an animated conversation about hospital safety the potential contribution of checklists to reducing medical errors and his upcoming book about the need for more transparency in the healthcare system. Marty was…

Read more »

See all book reviews »