Why Primary Care Is Undervalued

The Florida Times Union, September 25, 2011 | Go to article overview
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Why Primary Care Is Undervalued

If a new lawsuit is to be believed, a decline in the supply of primary care physicians is more than chance.

It is being caused in large part from payment schedules designed to favor specialists at the expense of the doctors on the medical front lines.

The issue was brought to the forefront by a group of primary care doctors based in Augusta, Ga.

This group, the Center for Primary Care, provides primary care to one-fourth of Augusta's population.

In the suit filed with the U.S. District Court for the District of Maryland against the U.S. Department of Health and Human Services, the doctors allege that a valuation process managed by the American Medical Association is influential in setting Medicare reimbursement schedules that undervalue primary care.

The AMA committee that comes up with the value is dominated by specialists, they claim.

Medicare is the largest single payer in the American health care system. So when Medicare sets rates, the impact spreads throughout health care system.

The AMA group is called the Specialty Society Relative Value Scale Update Committee - RUC for short.

Members must sign confidentiality agreements.

Thomas Scully, former administrator of the Centers for Medicare and Medicaid Services (CMS), has stated that the AMA system is "indefensible" and that "it's not healthy to have the interested party essentially driving the decision-making process."

That's called a conflict of interest.

The lawsuit quotes Kerry Weems, acting administrator of CMS, who stated that the schedule "disadvantages primary care" and "created distortions in our payment system that makes moving to value-driven health care difficult."


The AMA provided the following statement from Barbara Levy, a Seattle-area gynecologist who leads the RUC:

"The RUC is an independent panel of physicians from all medical specialties, including primary care, who make recommendations to CMS as all citizens have a right to do. These volunteers provide physicians' voice and expertise to Medicare decision-makers through their recommendations."

Levy understates the power of the RUC. CMS, which oversees Medicare, typically follow at least 90 percent of the RUC's recommendations.

Michael Maves, CEO of the AMA, wrote in a letter last April to U.S. Rep. Jim McDermott, D-Wash., that the RUC has consistently recommended increases for primary care and that primary care membership on the RUC is far greater than primary care services.

McDermott introduced legislation that would require the CMS to take into account the input of neutral third party analysts in addition to the RUC.

Nevertheless, a March report by the Congressional watchdog Medpac stated, "Compensation was lower for primary care physicians than for some specialists, and the disparity between them is large enough to raise concerns about equity and the future of the physician work force.

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