On Monday August 8, 2011, six physicians at the Center for Primary Care in Augusta, GA filed suit in a Maryland federal court against the US Department of Health and Human Services (HHS) and the US Centers for Medicare and Medicaid Services (CMS). The impetus for the suit is the longstanding relationship between CMS and the American Medical Association’s secretive, specialist-dominated Relative Value Scale Update Committee (RUC), which has resulted in a physician payment system that over-values specialty care procedures, under-values primary care, and creates systemic incentives to provide unnecessary and unnecessarily complex services. It is not unreasonable to argue that this single relationship is the core driver of runaway health care costs, threatening the stability of American health care economy and the larger US economy.
Here is the gist of the case:
- HHS and CMS, through Medicare and Medicaid, are required by law to fairly pay physicians for their services. Medicare’s neglectful acceptance of the RUC’s over-valuation of procedures reduced the number of medical-school students entering family medicine more than a quarter between 2002 and 2007. Put another way, only 48% of available family practice slots were filled by US senior medical students in 2011. That compared to 90% in Dermatology, orthopaedic surgery, otolaryngology, plastic surgery, radiation oncology, thoracic surgery, and vascular surgery. That means less access to primary care, with or without the federal health insurance law, for baby boomers and future generations.As a result, the primary care force in America has been decimated, resulting in poor quality and unnecessarily expensive care for Americans.
- CMS has done this by illegally delegating its valuation responsibilities to the RUC, often rubber stamping the RUC’s recommendations without further due diligence. More to the point, while CMS has relied primarily on the RUC to value medical services, functionally treating it as a federal advisory committee, it has not required the RUC to adhere to the management and reporting rules within the Federal Advisory Committee Act (FACA). In this, the physicians believe that CMS has colluded with the RUC and is out of compliance with the law.
- Medicare has acknowledged that the RUC’s recommendations are political and capricious, rather than based on reliable data.
Ultimately, this case has the potential to revise how medical services are valued and paid for, which in turn could have a positive impact on cost, and represents a real solution to the federal deficit. In other words, this case asks whether America should ration the health care delivered through its federal programs or, instead, pay for value and eliminate massive health care waste.
The dynamics and the negative consequences associated with the relationship between CMS and the RUC have been covered in detail at Replace the RUC. For deeper background on the problem, please check it out.
It is important to note that the physicians who have brought this case have funded it themselves. They have not asked for damages, so they do not stand to personally benefit if they win. Instead, they are using the legal system to try to effect systemic health care change in the public interest.
This site has been set up to seek donations from patients ($25), physicians ($100) and businesses ($500) to help us with this effort. These are only suggested amounts, of course. Give what you can to help turn around this terrible health care injustice.
Use the button on the right to contribute using PayPal or a credit card. Alternatively, send a check to: Save Primary Care, Box 2992, Evans, GA, 30809.