AAFP Calls For Revisions to RVU Formula
That's needed, McDermott says, because primary care physicians make up only one-sixth to one sixteenth of the RUC's membership, even though "primary care physicians provide about half of Medicare physician visits."
"CMS has depended on the AMA's RUC for recommendations as to the values assigned to Medicare service codes for over 90% of all code changes over the last 19 years," states language in the bill.
"The RUC lacks voting transparency and relies on self-reported and unrepresentative survey data that present serious conflict-of-interest concerns," the bill adds.
The RUC does identify and correct undervalued codes, but "it does not have the same incentives to find and correct overvalued codes. Specialists, especially those who derive the majority of their income through procedural codes, have no incentive to reduce the value of potential overvalued codes," McDermott's bill says.
Heim and Gary Rosenthal, MD, president of the Society of General Internal Medicine, said in a letter to House Speaker John Boehner they support McDermott's bill because analytical contractors – that second opinion – "will lend an element of depth, data, deliberation and inclusiveness not currently available to CMS or at the RUC."
The bottom line, Heim says is that "if we don't pay for the doctor who gives the good physical exam – methodologically, which is what we think needs to be better valued – if we don't do a better job of this, we're not going to have medical students going into primary care."
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