The GAO takes a swing at the RUC, curbing runaway cancer drug costs, and allowing patients autonomy

June 4, 2015

In order to bring you more of the news you want to read, RightCare Weekly summarizes and interprets three important articles and provides headlines linking to the many other articles and editorials you’ll find interesting. As always, RightCare Weekly presents articles related to moving our healthcare system toward the right care for all patients.

Join the conversation: Post your comments in our new section at the bottom of this page.



In the New York Times, Robert Pear highlights a report released from the Government Accountability Office, which concludes that Medicare relies too heavily on the American Medical Association to recommend fees for doctors who treat Medicare patients. Payment decisions may be biased, according to the report, since the 31 doctors who serve on the Relative Value Scale Update Committee, (known as the RUC), have potential conflicts of interest because they benefit when the government assigns higher values to their services. Here are the physicians on the panel today, and one account of previous members. Most are specialists nominated by their specialty societies, and not surprisingly, they tend to receive the higher payments. The paucity of primary care physicians on the panel leads us to question the fairness in the payments—that total $70 billion a year. To compound matters, Medicare fees also guide private insurers in their payments to doctors. “Medicare certainly needs clinical expertise to appraise the value of doctors’ services,” said Rep. Jim McDermott of Washington, who serves on the Ways and Means subcommittee on health. “But we give medical specialty societies an undue influence on their own payments. Medicare is a cash cow for specialists and not for family practitioners.”



Olga Khazan writes in The Atlantic about patients receiving surprise medical bills for services they thought would have been covered, or more extensively covered, by their insurer—even when they had visited in-network doctors. One survey shows a third of privately insured patients having received a surprise bill in which their insurer paid less than they expected. (Those who attended our last annual meeting remember a similar story from one of our speakers.) “Hospitals don’t tell patients how much they charge. Patients don’t know how much their insurers will pay until they get their bills. And the information in the bills isn’t publicly available, so there’s no way to know exactly how, why or to whom frequently surprise billing is happening,” the author concludes. The high cost of prescription drugs also adds to these worries. This week, Leonard Saltz, MD, of Memorial Sloan Kettering Cancer Center, in a speech to the American Society of Clinical Oncology, blasted the high cost of oncology drugs, citing figures showing the median monthly price for new cancer drugs in the U.S. had skyrocketed since 2000. Still, price increases had nothing to do with drug efficacies, he said in an article in the Wall Street Journal, and everyone should be concerned. “All of the stakeholders involved need to stop pretending that price is something we don’t need to discuss, but it affects all of us, and it’s affecting our ability to deliver quality care to everyone,” he said.



Providing high-quality and effective medical care means understanding and respecting patients’ needs and preferences, but it can be challenging to find the right path between inflexible protocol-driven care, and abdicating professional responsibility by leaving every choice to patients. Three stories this week illustrate different approaches to handing patient autonomy. Ravi Parikh, MD writes of a patient he saw recently who appeared to be hiding pills instead of taking them. The hospital care team effectively responded by putting a sitter in her room to watch her constantly, but Parikh worried this might have permanently damaged the patients’ relationship with the healthcare system.  That fear is borne out in a post by Jess Jacobs, a healthcare expert who writes about several of her worst experiences as a patient. Her experiences included being separated from her friend who was a med student advocating for her, and being subjected to a sitter she felt was unnecessary. Perhaps a better example of how to partner with patients to ensure they receive the right care is demonstrated by Daniela Lamas, MD, who writes of smuggling a Guinness to her patient in the hospital.  A system that makes room for simple gestures that acknowledge patients’ autonomy—and their humanity—ends up providing better care to all patients.





  • Earlier this week, we launched an interactive website dedicated to RightCare Action Week–our grassroots initiative that engages people across the country to take action to show what our healthcare system should look like. On, you’ll find an Action Forum, where you can submit, vote on, and discuss Action Ideas with your friends and colleagues. Sign up today to join us for RightCare Action Week.


  • The Lown Institute is accepting applications from incoming chief residents for the new RightCare Educator Program. Help shape a more rational medical culture by implementing RightCare Rounds in your institution. Deadline for applications is Tuesday, June 30. A small stipend will be provided. For more information, see here.




More responses to the New England Journal’s conflict of interest series


Patient communication and patient choice


Social determinants of health


Medical education


End-of-life care




Patient safety


Health reporting


Medicare payments


Health insurance


Selling sickness




Elder care




Medical culture


RightCare Weekly is made possible through the generous support of the Robert Wood Johnson Foundation.