A heart surgeon may receive far more money for their work than a general practitioner. This is due to the intricacies of medical billing, which affect not just the health care industry, but the level of care that you as a patient receive.
Medical billing depends on relative value units, or RVUs. These are the metrics that evaluate the time, complexity and skill of the work a doctor does. For decades, these RVUs have been the cornerstone of how physicians are paid.
RVUs are set by the Centers for Medicare and Medicaid Services (CMS) based on input received during an open regulatory comment process, according to the American Medical Association.
This process involves nearly 7,000 individuals and organizations that provide non-binding recommendations to the CMS. One of those groups is the Specialty Society Relative Value Scale Update Committee — known in medical circles as the RUC — an advisory board of 32 physicians and other healthcare professionals that has a significant pull in the process.
While the board's recommendations are not binding, it has led to criticism that physicians have a conflict of interest since they essentially recommend their own pay. It also raises concerns that the system drives doctors to become specialists so they will be paid more — which could leave little incentive for sharp medical minds to go into primary care.
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Some policymakers have spent years warning of these billing codes and skewed incentives, but the issue has received little attention due to its complexity and due to industry groups that are accustomed to how payments are set.
In 2013, the Washington Post ran an investigation that found the advisory board for the AMA repeatedly inflated the amount of time a physician needed to complete a procedure. IT also found the American Medical Association overwhelmingly accepted the board's recommendations.
