AEE16: The Destruction of Primary Care—A Short History, With Brian Klepper, PhD
August 31, 2021
16
09:53

AEE16: The Destruction of Primary Care—A Short History, With Brian Klepper, PhD

This conversation starts out talking about the RUC, which is a committee run by the AMA, who has the sole source contract with CMS to figure out how many RVUs any given procedure or service is worth. There are roughly four times as many specialists on this RUC committee as PCPs. You might be able to see where this is going, but let me let our guest in this healthcare podcast, Brian Klepper, explain how primary care got trampled by the goings-on.

Brian Klepper is a longtime healthcare analyst and former CEO of the National Business Coalition on Health.

You can learn more by emailing Brian at bklepper@worksitehealthadvisors.com.

Brian Klepper, PhD, is a healthcare analyst, commentator, and entrepreneur. He is a Principal of Healthcare Performance Inc, a healthcare strategy and business development practice, and CEO/Principal of Worksite Health Advisors, a benefits consultancy focused on linking high-performance/high-impact healthcare organizations with purchasers. He founded and moderates a popular professional healthcare Listserv, Healthcare Hackers, which is a discussion forum on healthcare high performance and value and which has about 850 participating benefits managers, benefits advisors, and innovative vendors.

An active author and speaker, Dr. Klepper has provided healthcare commentary to CBS Evening News, the Wall Street Journal, the New York Times, and the Washington Post. He has published widely in healthcare trade and academic publications and in newspapers nationally.

Brian is a regular contributor to Employee Benefit News, the Health Affairs Blog, The Health Care Blog, The Doctor Weighs In, Kevin MD, and other expert healthcare blogs. He is a reviewer for Health Affairs and The Journal of Ambulatory Care Management.

He is an advisor to the Lundberg Institute and to several for-profit healthcare organizations.

In his spare time, Brian is an offshore sailor.


01:00 What is the RUC?
03:18 What is the goal of the specialists in the RUC?
04:32 Why health plans and not health systems?
06:55 “All this time, the hospital community was waging war against the HMO community.”
07:59 “The incentives that have been at play have been very formidable.”
08:23 “Primary care has developed a reputation for being the easy specialty … and it’s just not so.”

You can learn more by emailing Brian at bklepper@worksitehealthadvisors.com.

healthcare,CMS,digital health,health tech,healthcare performance,ruc,ama,
|

Episode Support Provided By

Special Thanks to Our 2026 Sustaining Monthly Donors

Kimberly Carleson, Dylan Yahn, Benjamin Light, Matt McQuideAnn Kempski, Spencer Allen, Scott TromanhauserMarilyn Bartlett, 
Steven Elkins, Matthew Bunte, and Lori Smith.

Recent Episodes

EP517: The Business of Prior Auths: The 401-Level Financial Motive Behind Prior Auths
Relentless Health ValueJune 24, 2026
517
27:2325.07 MB

EP517: The Business of Prior Auths: The 401-Level Financial Motive Behind Prior Auths

Listen on Your Favorite App Hello, Relentless Health Value Tribe. Welcome to it. So, yeah … last week, I had a great conversation with Ophelia Johnson ( EP516 ) that is a companion show, I would say, to this one. So, listen to that one first. Listen to this one first. You do you. For a full transcri...

EP516: GLP-1s and Cash Pay From the Pharma Manufacturer Point of View, With Ophelia Johnson
Relentless Health ValueJune 17, 202644:0540.35 MB

EP516: GLP-1s and Cash Pay From the Pharma Manufacturer Point of View, With Ophelia Johnson

Listen on Your Favorite App Hello, all you Relentless Tribe members. Welcome to it. Today we have a show that will bend your mind in new directions. And yes, I have a head cold at a very weird time of year. I have trouble apparently doing things like normal people. Anyway, we talk a lot on this podc...

EP515: SNF (Skilled Nursing Facility) Fraud—Or Is It Fraud? With Michelle Cera, PhD
Relentless Health ValueJune 10, 202643:0739.47 MB

EP515: SNF (Skilled Nursing Facility) Fraud—Or Is It Fraud? With Michelle Cera, PhD

Listen on Your Favorite App Hello, all you Relentless Tribe members. Lately, I have been just obsessed with what's hiding in plain sight: the root cause glitches in how American healthcare is built. Not the symptoms now. Not the noise. The actual ground zero. I mean, what we call healthcare in this ...

EP514: Successfully Suing a Health System for Their Anticompetitive Contracts and Also Collecting Damages for Plan Sponsors and Members, With Matt Cantor
Relentless Health ValueJune 03, 2026
514
43:4340.02 MB

EP514: Successfully Suing a Health System for Their Anticompetitive Contracts and Also Collecting Damages for Plan Sponsors and Members, With Matt Cantor

Listen on Your Favorite App Hello, all you Relentless Tribe members. This is the third episode in our legal goings-on trifecta, starting with Doug Aldeen in episode 512 covering what amounts to the main reasons plan sponsors wind up suing their brokers or employee benefit consultants. For a full tra...

EP513: Revisiting Cunning Anticompetitive Hospital Contracts, With Brennan Bilberry

EP513: Revisiting Cunning Anticompetitive Hospital Contracts, With Brennan Bilberry

Listen on Your Favorite App If you are a large employer, union funds broker, fiduciary, or anyone responsible for a health plan that spends half of its dollars on hospital care (which most do), or if you have anything to do with policy or enforcement of policy, yeah … listen this week and next week....

EP512: 3 Kinds of Broker/EBC Rent-Seeking Payment Models—A Lawyer’s Perspective, With Doug Aldeen

EP512: 3 Kinds of Broker/EBC Rent-Seeking Payment Models—A Lawyer’s Perspective, With Doug Aldeen

Listen on Your Favorite App I wanted to talk to a lawyer ’cause, yeah, lawyers are the ones that see stuff that falls the whole way down to the level of legal action. But I wanted to find out what are the main categories of things that wind up in legal land when it comes to broker or EBC (employee b...

EP511: The Tension When Clinical Teams Take On Risk for Policymakers and Others Looking to Rustle Up Future Perverse Incentives, With Dr. Siva and Monica Lypson, MD, MHPE
Relentless Health ValueMay 14, 2026
511
29:3727.1 MB

EP511: The Tension When Clinical Teams Take On Risk for Policymakers and Others Looking to Rustle Up Future Perverse Incentives, With Dr. Siva and Monica Lypson, MD, MHPE

Listen on Your Favorite App Last week, we talked Medicare Advantage with Betsy Seals ( EP510 ), and we talked about finding members who a plan can serve well. This makes sense because Medicare Advantage is a capitated program. In other words, Medicare Advantage plans get paid by CMS a per member per...

Listen and Follow

Sponsored by Aventria Health Group
©2026 BD Bridges LLC. All Rights Reserved.