The secrets of the RUC, a pattern of hospice abuses, and overspecialization in “Doctored”: RightCare Weekly

 August 28, 2014

In order to bring you more of the news you want to read, RightCare Weekly, starting this week, will be summarizing and interpreting three important articles and providing 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.




Since the 1990s, a secretive committee of the AMA has been extremely influential in determining Medicare reimbursement rates for doctors by evaluating the relative value of services that physicians perform. The composition of the AMA’s Specialty Society Relative Value Scale Update Committee, or RUC, is heavily skewed towards specialists, and short on primary care physicians. Not surprisingly, the RUC’s recommendations for who gets paid what favor expensive specialists over primary care. Neither the RUC’s deliberations nor its recommendations are public, but Medicare nearly always accepts the recommendations. Medicare payment rates serve in turn as the baseline for how other insurers pay doctors. Many policymakers think U.S. primary doctors are underpaid relative to specialists, with a host of consequences that drive healthcare spending up and lead to worse care. In her Politico article, Katie Jennings writes that efforts are underway to open up the RUC’s deliberations, thanks in part to the ACA.


Peter Whoriskey and Dan Keating of the Washington Post have written a disturbing series of articles on hospice care in the U.S. Hospice offers a more humane option for patients at the end of life who would like to avoid invasive (and often futile) treatment, but the series documents a pattern of poor care and apparent neglect by many hospice providers. Some for-profit programs are leading offenders. According to one hospice doctor quoted in the story, “…some of the new hospice providers may not have the same values – they may be more concerned with profit margins than compassionate care.”


Time takes a closer look at a newly released memoir by Sandeep Jauhar, MD. Doctored: The Disillusionment of an American Physician discusses the rise of specialists (and loss of primary care) as one reason our health care system is “costly, sloppy, and disorganized.” Jauhar’s solution: increasing patient education, general health literacy, and accountable care organizations. He was also interviewed on NPR’s Fresh Air.



Call for Applications: The deadline is this Sunday, August 31, to apply for the National Physicians Alliance 2014 Copello Health Advocacy Fellowship. NPA is recruiting physician advocates to be part of movement addressing challenges to achieving high-value health care, including price, waste and overtreatment. Applicants must email a brief statement of interest with a CV. For details, visit the NPA website.



Quality of care

  1. Simple measures made hospital patients 70% more likely to quit smoking – Karen Kaplan, LA Times
  2. Surgical ‘black box’ could reduce errors – Chethan Sathya, MD, CNN
  3. To improve medical care, enlist pharmacists – Steven C. Anderson and Michael Malloy, PharmD, Boston Globe


Compassionate medicine

  1. Food and the Dying Patient – Jessica Nutik Zitter, MD, New York Times’ Well blog
  2. In Redesigned Room, Hospital Patients May Feel Better Already – Michael Kimmelman, New York Times
  3. Dealing with physicians who have lost empathy and compassion – Val Jones, MD, KevinMD


Healthcare system

  1. Wanted: More Doctors for Old People – Megan McArdle, Bloomberg View
  2. Québec Medical Association Unveils an Action Plan for Overdiagnosis That Would Allow Major Health Budget Savings
  3. Ohio Cardiologist Indicted for Healthcare Fraud, Criminal Act – Shelley Wood, Medscape
  4. Nurse practitioners fight for more independence – Laura Ungar, USA Today
  5. Leading Pediatrician: Sick Time Is Health Issue; Will Doctors Step Up? – Carey Goldberg, WBUR
  6. You Think Financing U.S. Health Care Is Bizarre? Check Out 340B Drug Pricing – Uwe Reinhardt, Forbes
  7. Chicago and 2 California Counties Sue Over Marketing of Painkillers – John Schwartz, New York Times
  8. Blood Industry Shrinks as Transfusions Decline – Matthew L. Wald, New York Times


The Right Care Weekly is made possible through the generous support of the Robert Wood Johnson Foundation.