Acronyms have always dominated the practice of medicine and one of the older ones is RVS or Relative Value Scale. Simply stated, although far more complicated in reality, the RVS sets the fee structure that physicians will be paid by insurance companies and agencies such as Medicare and Medicaid. A lesser known acronym is RUC which represents the real power behind the RVS. This entity, the Relative Value Scale Update Committee (RUC), evaluates physician’s procedures and makes recommendations to the CMS or better known at the Centers for Medicare and Medicaid Services. These reimbursement recommendations are almost always followed, i.e., ninety percent of the time. More alarmingly, they almost always favor dramatic increases for specialists rather than primary care physicians…six times more frequently.
Why is this disparity so important one might ask? It is terribly important for a whole host of reasons. These include:
The compensation disparity between specialist and primary care docs widens geometrically. Specialists now earn $135,000 per year and $3.5 million during a career more than a primary care doctor;
- Clearly, with this type of incentive, many more docs are becoming specialists and eschewing the field of primary care;
- The PCP base is shrinking at exactly the time we need it most;
- The new Health Care legislation is heaping 37 million more Americans into the health care system and they all need a PCP
Income disparities shape medical student specialty choice Specialty and geographic distribution of the physician workforce: what influences medical student and resident choices? March 2009. Accessed January 4, 2010
It is not just “Houston” that has a problem…it is the American health care system and all Americans. Soon the waiting time for a PCP appointment will lengthen to dangerous intervals. Overworked and underpaid docs will be the norm and that isn’t good for anyone.
One solution is concierge medicine or often referred to as Direct Care. A Direct Care practice denotes an experienced primary care physician who limits his or her practices to 300 to 400 patients and works for an annual fee rather than accepting insurance payments. This allows patients to receive the care they need and deserve and PCP to practice medicine in a thorough and safe manner while achieving a reasonable earnings level.