Should payers add a "C" – to reflect 'cognitive value' – to the physician relative value unit (RVU) formula and thereby increase primary care physician pay? Would that help improve the supply of family physicians, pediatricians and internists?
The American Academy of Family Physicians thinks so, and has created a special task force to increase efforts to add cognitive value to the relative value unit physician fee formula, which now consists only of work, practice expenses and malpractice costs.
Yes, it's another task force. But this time, things are getting serious. The issue has been brewing for decades but recently reached a bubbling point – spawning the task force – because of two key factors, explains Lori Heim, MD, AAFP's immediate past president and task force chairwoman.
First, there's a gap – as there should be – between what primary care providers get paid by the RVU versus what specialists or proceduralists get paid, she says. But it is far too wide considering the amount of work a primary care provider has to do to take care of a typical patient, she says.
The mean compensation of a primary care provider is less than 55% that of other medical specialties, according to a report last December from the Council of Graduate Medical Education (COGME), these elements threaten the supply of primary care providers. It should be more like 70%, the report says.
Second, "the complexity of patients seen in primary care offices has changed over time so that today it is far more complicated, with far more co-morbidities," Heim said in a telephone interview. "People don't just come in with a sore throat. Today, it's 'I have depression, diabetes, a past heart attack and by the way, I also have a sore throat.' "