Dividing the Medicare pie pits doctor against doctor

One of the biggest disputes in the Relative Value Scale Update Committee came in 2005, when members clashed over primary-care groups' push for increases in the payments for doctor office visits, which are among the most commonly-billed Medicare services.

The primary-care societies argued that visits had become more challenging, partly because patients were older and had more complex conditions. At one point, the debate reached such an impasse that J. Leonard Lichtenfeld, who represented the American College of Physicians, and at least one other RUC member, Tom Felger, who represented family physicians, actually came close to ending their involvement in the talks, and asked for a break in the meeting, according to both men. They felt a surgical faction was blocking their push, they say.