But there is one outstanding feature of the Post story that the AMA does not refute. While the AMA spends upwards of $7 million on evaluation of values and possible pay scales, the government has only about a half-dozen part-time workers on the payment reviews, certainly deflating its ability to regulate or control pay for relative value of procedures.
Here we have it: the government, so very regulation-oriented, has decided not to spend money to hire people to carry out the very regulations it imposes, or to oversee the enormous responsibility and expense of physician pay. So it certainly puts itself in a position to rubber stamp the AMA, or anybody else.
As for most physicians, they are caught in the middle, as per usual. The Post disclosures don't really faze him, says Hyde. "My reaction to it is neither 'up' nor 'down,' he adds. As doctors face regulatory and payment issues, "the only collective action that physicians can take, is through our large and increasingly powerful health systems, or in the alternative, through a rapprochement between the regulated and the regulators," Hyde says. "The RUC, as I see it, represents such an understanding."
Hyde emphasized that Medicare isn't "compelled" to accept the RUC's recommendations, but its role, he says, may be important to prevent even more physicians from leaving their practices.
"What the doctors and CMS do through the medium of the RUC is, I think, attempt to keep as many physicians involved in practicing medicine for Medicare and Medicaid beneficiaries as possible," Hyde says, noting the fascinating, and always complex, world of the regulated and the regulators.