Specialists Losing to Generalists on Relative Value Pay Panel

Specialists and generalists have sparred for years on the physicians' committee that helps determine what each specialty is paid, but generalists have lately been winning pay increases at the expense of specialists, according to a report by the Wall Street Journal.

Representatives of primary care groups on the Relative Value Scale Update Committee have complained that procedure-oriented specialists are too heavily represented on the panel. Cardiothoracic surgeons, otolaryngologists and neurosurgeons are among the 23 specialty society representatives on the committee.

Generalists say their cases are becoming more challenging, in part because patients are older and have more complex conditions. Surgical groups say there is no convincing evidence of this. Nevertheless, generalists are winning substantial increases in relative values, leading to higher pay.

RUC Chairwoman Barbara Levy, MD, a gynecologist, denied that RUC members vote in blocs tied to their specialties' interests. But in a recent piece in Kaiser Health News, she noted that payments to primary care physicians have increased by more than 20 percent since 2006, in part due to recommendations by the RUC. Changes in relative values are "ultimately budget-neutral," she added. "Therefore, if the RUC considers increases to valuation for one service, the valuation of all other services will decrease."

CMS is the ultimate arbiter on how relative values translate into physician payments. Jonathan Blum, a CMS deputy administrator, told the Wall Street Journal that the agency is moving to "improve Medicare's physician systems to correct historical biases against primary-care professionals." Several CMS changes have boosted primary care service payments this year, and primary care physician reimbursements will be boosted more next year.

The RUC, operated jointly by the AMA and the specialty societies, quantifies aspects of medical care like physician time, intensity and practice costs to create a relative value. Relative values are then adjusted geographically and multiplied by a dollar conversion factor determined by Congress to determine payment for each service.

Read the Wall Street Journal report on physician pay.

Read Dr. Levy's article in Kaiser Health News.

Read more coverage of the Relative Value Scale Update Committee:

- Temper AMA Panel's Power Over Physician Fees, Healthcare Economist Proposes

- Study Finds Clinical Volume Drives Compensation For Most Multispecialty Groups

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