RUC needs more primary care and less secrecy, weakening of FDA oversight, and value of ‘Surgeon Scorecard’?

July 23rd, 2015

July 23, 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 section at the bottom of this page.


For too long, a secretive committee of the AMA has been recommending payment values for physicians who treat Medicare patients. The panel, the Relative Value Scale Update Committee, or RUC for short, is comprised of mostly specialists who have a vested interest in inflating their own procedure-driven work. Last month, RightCare Weekly wrote about the RUC and a new report from the U.S. Government Accountability Office that criticized it, citing it relied too heavily on AMA’s recommendations. RCW questioned the fairness of their recommendations because of the paucity of primary care physicians represented on the panel. Lown Institute leaders, Vikas Saini, MD and Shannon Brownlee, MSc, in a new commentary, assert that overpaying specialists hurts patients. Among the reasons, they say, is that overpayments lead to physician overtreatment incentives. Instead, they urge Medicare to conduct its own evaluation of suitable fees for medical services. By the way, RUC-recommended fees currently serve as a guide for private insurers, further driving up healthcare costs and discouraging new physicians from entering primary care. “At the very least,” the authors contend, “the AMA should level the playing field. Add more primary care doctors to the RUC. Open the committee’s books, share the data that drives the payment decisions and make all values fair.”


Kudos to the The New York Times Editorial Board this week for blasting provisions of a bill passed by the House of Representatives, intended to hasten FDA’s approval process for “breakthrough technologies” believed to work—but not scientifically proven to do so. The 21st Century Cures Act, would allow anecdotal evidence for approving medical devices—subjecting millions of Americans to unsafe and untested devices. The bill would also speed up the use of new antibiotics by giving hospitals financial incentives to use them, thereby encouraging overuse. In an op-ed in the Times, authors Rita Redberg, MD and Sanket Dhruva, MD, refer to implanted medical devices that later were found to be dangerous to patients and further call into question already weak FDA oversight. “This [bill] would allow a device to be approved based on even lower standards of evidence than are currently used, on the theory that the need outweighs the risks,” the authors conclude. “Stricter evidence standards and increased federal funding of the FDA are needed to ensure that innovative medical devices lead to better health,” they said. But Sandra Bond Chapman, PhD, founder of the Center for BrainHealth at the University of Texas, disagrees. Writing in, she supports the bill, stating, that it “typically takes 20-40 years or more for scientific discoveries to trickle down to benefit human lives… None of us can afford to wait a single day, let alone 40 years—especially those with brain injury or brain disease!”


ProPublica recently released a highly controversial “Surgeon Scorecard,” listing the complication rates of almost 17,000 surgeons in the U.S. who perform eight common elective procedures. Its authors consulted with experts and made a number of adjustments to account for patient mix and factors that may minimize or exaggerate complication rates. They found incredible individual variation between surgeons. While some, like Ashish Jha, MD, of the Harvard T.H. Chan School of Public Health, are calling this tool “a step in the right direction,” others vehemently disagree. Many raise serious concerns about the soundness of its methodology and the unintended consequences of making such information available to the public. Experts opine that that this report will discourage surgeons from treating complex patients, that it fails to measure the outcomes that actually matter, that data limitations inaccurately represent complication rates, and that patients may not be interested in accessing this data anyway. While the movement toward increased transparency is laudable, much work is still needed to ensure that patients are able to make decisions about their care based on sound data.



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