"But even when those were designed, people were saying, we're just not good about getting to the 'thinking' part of what happens in that office. If you talk at length with a patient, for example. Or how much is it worth that I counsel you on not only your cough, but I also spend time talking about what to do about your smoking...which compounds the weight problem you have, and how weight affects your diabetes."
The doctor who gives the good physical exam is worth it for the payers and for patients, she explains. "Take someone who comes in with shoulder pain. The PCP would likely spend some time taking a complete history, asking what are the things you have been doing, could it be musculoskeletal, was there trauma or a fall, or could it be a heart or lung problem, or gastrointestinal? There's a multitude of potentials."
Isolating the problem as musculoskeletal early avoids sending the patient to the cardiologist, the gastroenterologist, the pulmonologist.
The issue is getting traction from Congress as well. The RVU is reviewed by the American Medical Association's 29-member RUC or Relative Value Scale Update Committee. But that committee, whose members are primarily procedural specialists, is under fire from Rep. Jim McDermott (D-WA), who also is a physician.
McDermott's 2011 proposed legislation, HR 1256, calls for the Centers for Medicare & Medicaid Services to pay for a "second opinion" of the RUC's determinations related to changes to the CPT billing codes used by all physicians to submit claims.