Apr 4, 2014 • 23M

All "RUC'ed" Up or The Problems With How Physician Reimbursement is Determined: A Conversation with Kavita Patel (April 7th)

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David Introcaso, Ph.D.
Podcast interviews with health policy experts on timely subjects. The Healthcare Policy Podcast website features audio interviews with healthcare policy experts on timely topics. An online public forum routinely presenting expert healthcare policy analysis and comment is lacking. While other healthcare policy website programming exists, these typically present vested interest viewpoints or do not combine informed policy analysis with political insight or acumen. Since healthcare policy issues are typically complex, clear, reasoned, dispassionate discussion is required. These podcasts will attempt to fill this void. Among other topics this podcast will address: Implementation of the Affordable Care Act Other federal Medicare and state Medicaid health care issues Federal health care regulatory oversight, moreover CMS and the FDA Healthcare research Private sector healthcare delivery reforms including access, reimbursement and quality issues Public health issues including the social determinants of health Listeners are welcomed to share their program comments and suggest programming ideas. Comments made by the interviewees are strictly their own and do not represent those of their affiliated organization/s.
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Since 1992 use of the RBRVS (Resource Based Relative Value Scale) has been the prevailing method by which physician procedure prices are determined.  The method or formula for determining prices is managed by the AMA's RUC (or the Relative Value Update Committee).  In recent years the RUC has come under increasing criticism largely because their work perversely incents the use or overuse of higher priced medical procedures. The RUC has been a topic of Congressional hearings over the past few years and just this past week the Congress included a provision in the so called "doc fix" bill to have the DHHS Secretary begin to collect information on physician services to better determine relative values in setting physician fees.  

During this 23 minute conversation Kavita discusses how the RUC determines prices, the AMA's defense of the RUC process, what effect price skewing has on the practice of primary care and how the RBRVS might be reformed.   

Dr. Kavita Patelis a Fellow in the Economic Studies program and Managing Director for clinical transformation and delivery at the Engelberg Center for Health Care Reform at the Brookings Institution.  She is also a practicing primary care internist at Johns Hopkins Medicine.  She served previously in the Obama Administration as Director of Policy for the Office of Intergovernmental Affairs and Public Engagement in the White House.  Dr. Patel also served as Deputy Staff Director for the late Senator Edward Kennedy.  She too has an extensive research and clinical background having worked as a researcher at the RAND Corporation and as a practicing physician in both California and Oregon.  She earned her medical degree from the University of Texas and her masters in public health from the UCLA.