There are two recent posts that deserve a read:
Paul M Fischer and Brian Klepper's Open Letter to PCPs alerts us to the deleterious effects of the RUC - the Resource Utilization Committee of the AMA. This committee of 29 has a representative from each of the primary care specialties: Family Medicine, Pediatrics, Internal Medicine. That's about 10% of the voting power.
No shock at all to discover that the RUC recommends payment shifts that reward complex procedures at the expense of the fundamental work of primary care. What may be a surprise to many is that the Centers for Medicaid and Medicare Services accept about 94% of the RUC recommendations. Procedures over primary care is one of the main drivers of our incredibly expensive and dysfunctional health system: we have the best rescue system in the world fed by the missed opportunities and failures in early intervention based on a hamstrung and demoralized primary care workforce.
The net effect is that the RUC is the hand on the tiller steering the US health care boat over the precipice.
Read their letter and send it on. It is time to uncouple payment policy from the destructive recommendations of the RUC.
The second post: How to Fix Primary Care - Step 1 urges primary care to take off the kid gloves and start fighting for what is right. Dr George A Lundberg calls for putting the RUC recommendations aside (and this from the guy who was the AMA's Editor in Chief for Scientific Information - overseeing JAMA among other things!).
Dr. Lundberg: "No more Dr. Nice Guy PCPs until you do a better job of fixing our broken system."
The bottom line: primary care is the foundation of high performing health systems. We must push back against the systematic underfunding of our work, the payment and policies that hamstring what our patients need. We are not an afterthought or a 'loss-leader,' with our work on prevention, early diagnosis and intervention we are the key to achieving high quality lower cost care.