AMA's RUC panel skews payments toward specialists

The American Medical Association's (AMA) power in determining the relative value of the services physicians provide plays an outsize role in favoring specialist physicians and driving up the costs of healthcare delivery in the United States, Politico reported.

The AMA holds the copyright on the "Current Procedural Terminology" or CPT codes. It reaps huge profits from this coding system--perhaps more than double what it receives from its membership, according to Politico. It formulates those codes using a secretive 31-member panel, the Relative Value Scale Update Committee (RUC), which is overloaded with specialists and has little oversight. Partly as a result, the CPT coding system contains relatively few codes for primary care physicians beyond the standard office visit.

In one example, a primary care physician who ordered a patient back to the hospital after his chest pains subsided, received no payment for arranging emergency catheterization provided by a cardiologist. And that physician was unaware of the AMA's role in setting pricing for care until very recently.

Only 30 percent of practicing physicians in the United States are primary care specialists, according to Politico. That compares to 50 to 70 percent in other countries. That imbalance may also lead to higher costs in the U.S. "Primary care doctors often treat patients before their conditions get so complicated that they need to seek specialty care, which of course drives up health costs enormously," Politico said.

Although 2011 litigation to provide more regulatory oversight regarding the AMA's setting of CPT codes was defeated in court, the recent posting of payments to physicians by the Medicare program shows it is skewed toward specialists. And some payers also press for more payment parity for primary care physicians in order to reduce costs, Politico reported.

To learn more:
- read the Politico article