How the AMA Has Undermined Primary Care
This is Brian Klepper, writing at The Health Care Blog:
While, in other developed nations, 70-80 percent of all physicians are generalists and 20-30 percent are specialists, in America the ratio is reversed, the result of a payment system, the Resource-based Relative Value Scale (RBRVS), that was originally intended to account for and financially lessen the differences between specialties. Instead, RBRVS has evolved to reward expensive care and penalize proactive management, even though the data are unequivocal that higher percentages of primary care within a community results in healthier, lower cost populations…
In a June 2007 Annals of Internal Medicine article…Bodenheimer et al, provide this example:
Under the RBRVS system, the 2005 Medicare fee for a typical 25- to 30-minute office visit to a primary care physician in Chicago was $89.64 for a patient with a complex medical condition…. The 2005 Medicare fee was $226.63 for a gastroenterologist in the outpatient department of a Chicago hospital performing a colonoscopy … which is of similar duration to the office visit. Colonoscopy performed in a private office in Chicago, which differs from the hospital setting because the gastroenterologist pays for equipment and nursing time, would cost $422.90…
Under the auspices of the AMA and in alliance with CMS [RBRVS codes] appear to have played a direct role in the current primary care crisis by driving policy that financially favored specialty care at the expense of primary care.
Who would claim that chatting with a patient is anywhere near as difficult as a colonoscopy?
The difference in payments appears to be “fair” — but: outside of the Soviet Union or North Korea, why should the government (Medicare) be in the business of price fixing?
These guys are supposed to be representing primary care docs!!!
The AMA is out for the AMA. Screw the docs.
The AMA sold the doctors out. What else is new?
I keep wondering if the AMA, like AARP, has violated some law. Maybe the criminal law.
The academic teaching hospital in Denver has purchased a bill board near the Colorado capitol, presumably so that inbound legislators will get its message.
The message is “more specialists = better survival.”
Apparently they didn’t get the primary care talking points memo.
The RBRVS system has the unintended consequence of changing the distribution of doctors based on arbitrary reimbursement levels for various specialties. This partly explains why few medical students want to enter the field of primary care.
We all can agree there is a growing shortage of primary care physicians. Yet, I have seen no evidence that boosting the number of primary care doctors (and reducing specialists) would have a positive effect on health. There is this widespread belief that encouraging (or compelling) people to see their doctor more often (having more tests done) will catch diseases early, improve health and save money. But there’s no evidence to support this belief.
Linda alludes to an important point. When you have a serious problem, you need a physician with specialized knowledge of your condition.
Linda, I bet our tax dollars helped pay for that bill board.
We need to shorten the income gap between primary care docs and specialists.
So if this trend continues, who will be doing the basic screening – emergency room physicians? This is a significant problem! If all that is left at the end of the day is specialists, we are going to be in a world of hurt – figuratively and literally.
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