Six family physicians in Georgia have filed a lawsuit accusing Medicare of illegally relying on a committee of the AMA that have been responsible for keeping reimbursement rates to primary care physicians much lower than those for specialists.

This committee is the Relative Value Scale Update Committee (RUC), formed in 1991. It determines the amount of reimbursement for each medical service, which is assigned a relative value unit (RUV), based on the level of physician work (time, effort, skill and stress), the physician's practice expenses and a malpractice element.

As pointed out by the lawsuit, RUC membership is highly biased toward specialties and only 2 seats out of the 29 truly represent primary care. In addition, the RUC recommendations are based on practice data collected by medical societies using a survey methode that is also biased as well as capricious. Finally, the RUC is secret and does reveal the basis for its decisions.

COMMENT: I have already outlined all these points in Chapter 6 of my book, BOOM or BUST: CONQUERING DISEASES OF AGING and they are definitely true. In Chapter 8, I show why specialty care in the U.S. drives up the costs of health care while at the same time providing less quality. The inequity of reimbursement is the driving reason why primary care is quickly disappearing from our health care system and the RUC is a primary culprit.

I also stated that the RUC excludes the outcome or value of a test or procedure from its determinations. It commonly pays high reimbursement for procedures that have little chance of improving a condition while not reimbursing treatments that have much higher success rates at much lower costs.

With this is mind, I hope the lawsuit is successful, but in reality, the lobbying power that specialty organizations have will be too great to overcome.