“Anyone who isn’t confused really doesn’t understand the situation.” That’s a quote by Edward R. Murrow and very apropos. I started thinking about this conversation that I had had with Brian Klepper, PhD, because so much going on right now—so many discussions and dissections taking place about primary care financial struggles, about what is value in healthcare. And the RUC (Relative Value Scale Update Committee) is, at a minimum, an underlying factor; but yet it doesn’t come up. Almost ever. Merrill Goozner called the RUC the AMA’s (American Medical Association’s) “dark secret,” and I can see why.
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Just one procedural note before I roll tape with Brian Klepper. We’re gonna go a little rogue today because you kind of got to understand what the RUC is before I can get into the two points I really want to make about it. So, here’s my outrageous plan, which will shake up our standard Relentless Health Value format.
Today, I’m gonna make the points I want to make after the interview, not before, like usual. I will, however, just mention the two points so you can keep them in mind as I talk with Brian. Here’s the first point, and it’s about the doomed financials of primary care. Why is it that primary care has a lot of times no business model unless part of the business model includes driving profitable downstream utilization? And when I say utilization, do I mean services with bigger RVUs (relative value units)? Why, yes, I think I do. We’ll dig into this later.
Here’s my second point, and it’s my view on the nature of any postulations that the “value of healthcare services” is equivalent to the prices that we pay for said services. Again, more on that later, but here is my original conversation with Brian Klepper.
Brian Klepper is a longtime healthcare analyst and former CEO of the National Business Coalition on Health.
Also mentioned in this episode are Merrill Goozner and Elizabeth Mitchell.
People who have written about primary care: Scott Conard, MD; Paul Buehrens, MD, FAAFP; Larry McNeely; Primary Care Collaborative; Nisha Mehta, MD; Dan Mendelson; Tony Lin, MD; Juliet Breeze, MD; Raymond Tsai, MD; Linda Brady; Guy Culpepper, MD; David Muhlestein, PhD, JD
You can learn more in this article and on the AMA Web site.
Brian Klepper, PhD, is principal of Worksite Health Advisors and a nationally prominent healthcare analyst and commentator. He speaks, writes, and advises extensively on the management of clinical and financial risk, on high-performance healthcare, and on realizing the potential of primary care.
His current focus is on high-performing healthcare organizations that consistently deliver better health outcomes at lower cost than usual approaches in high-value niches and how, integrated with advanced primary care, they can be configured into turnkey comprehensive high-value health plans that can disrupt the status quo.
02:29 What is the RUC?
06:26 Why is primary care not the “easy” specialty?
09:42 What are three low-value things per RUC?
10:33 EP436 with Elizabeth Mitchell.
10:38 What is a root cause of why primary care doesn’t get paid more?
12:50 Why doesn’t value equal money?
You can learn more in this article and on the AMA Web site.
Recent past interviews:
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Elizabeth Mitchell, David Scheinker (Encore! EP363), Dan Mendelson, Dr Benjamin Schwartz, Justin Leader, Dr Scott Conard (Encore! EP391), Jerry Durham (Encore! EP297), Kate Wolin, Dr Kenny Cole, Barbara Wachsman