Category Archives: Uncategorized

The Augusta Primary Care Physicians Lose Their Appeal

On January 7th, the 4th Circuit of the US Court of Appeals rejected Fischer et al’s appeal. The opinion gave their arguments short shrift and dismissing the case out of hand, with much discussion. As a practical matter, this exhausts the Augusta primary care physicians’ legal remedies to CMS’ and HHS’ sole source relationship with the AMA’s RUC.

There are still paths to pursue, particularly if Congress and/or the White House were to find reason to bring pressure on CMS to change either the way it determines the value of medical services, or the parameters of its relationship the RUC as an advisory organization.

More later.


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The Most Powerful Health Care Group You’ve Never Heard Of

Brian Klepper and Paul Fischer

Posted 8/06/12 on Medscape Connect’s Care and Cost Blog

Excessive health care spending is overwhelming America’s economy, but the subtler truth is that this excess has been largely facilitated by subjugating primary care. A wealth of evidence shows that empowered primary care results in better outcomes at lower cost. Other developed nations have heeded this truth. But US payment policy has undervalued primary care while favoring specialists. The result has been spotty health quality, with costs that are double those in other industrialized countries. How did this happen, and what can we do about it.

American primary care physicians make about half what the average specialist takes home, so only the most idealistic medical students now choose primary care. Over a 30 year career, the average specialist will earn about $3.5 million more. Orthopedic surgeons will make $10 million more. Despite this pay difference, the volume, complexity and risk of primary care work has increased over time. Primary care office visits have, on average, shrunk from 20 minutes to 10 or less, and the next patient could have any disease, presenting in any way.

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An Overview of the RUC and the Problems It Represents

This PowerPoint provides the background on the RUC that Brian Klepper presented at the National Medical Home Summit in Philadelphia in February 2012. It tries to deliver a concise explanation of the structural issues involved.



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The Relationship Between Primary Care Income and Medical Student Interest

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Primary Care Ready To Rumble Over the RUC

Mary Ellen Schneider, Family Practice News Digital Network

First posted 6/30/11 on Family Practice News

LogoLeaders at the American Academy of Family Physicians are calling on the American Medical Association to give primary care a greater voice on the committee that recommends how much physicians should be paid for Medicare services.

The Specialty Society Relative Value Scale Update Committee, or RUC, which is operated by the AMA, makes annual recommendations to the Centers for Medicare and Medicaid Services for how to value a number of physician services under Medicare. The 29-member panel includes representatives from various medical specialties and primary care.

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How to Fix Primary Care – Step 1

On MedPage Today, Editor-at-Large George Lundberg, MD comments on this effort and on American health care’s need to re-empower primary care. Dr. Lundberg is the former Editor-in-Chief at Medscape and JAMA.

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Hello and Welcome. I’m Dr. George Lundberg and this is At Large at MedPage Today.

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