Doctors Sue HHS, CMS Over 'Secretive' Payment Committee

John Commins, for HealthLeaders Media , August 11, 2011

Fischer says the existing payment structure that RUC has dominated is a huge driver of healthcare costs. "We have too many specialists doing too many unnecessary procedures and the price that we pay doctors has been fixed by this secret little committee of the AMA. That is illegal," he says. "Let's come up with a better way of pricing physician services more in line with the value they provide to the society."

The suit notes that CMS has historically accepted more than 90% of RUC recommendations. The resulting higher income for specialists has discouraged medical students from primary care and exacerbated the nation's shortage of generalist physicians, the plaintiffs contend. 

Barbara Levy, MD, chair of the RUC, issued a statement that acknowledged the lawsuit but did not talk about the specific allegations. "The RUC is an independent panel of physicians from all medical specialties, including primary care, who make recommendations to CMS as all citizens have a right to do. These volunteers provide physicians' voice and expertise to Medicare decision-makers through their recommendations," Levy said.

Fischer says his group tried to go through traditional channels to have their grievances heard but that they were ignored by the AMA and the American Academy of Family Physicians. "The first thing we did was go to them almost a year ago to support this effort. But AAFP sits on the RUC. They are part of the problem. When they were unwilling to do anything I decided to go it alone," Fischer says.

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