1/ Kudos to @CMSGov for following through on intentions to increase relative pay for "the kind of care where clinicians need to spend more face-to-face time with patients, like primary care and complex or chronic disease management."

#PhysicianFee

2/ When the "relative value units" for every billable procedure in healthcare is set, new technology/ procedures tend to get high assessments of complexity and effort.

When, over time, specialists get really good (and quick) at them, these "RVUs" are rarely revised downwards

3/ this is part of the reason why there is such a big disparity in pay in the US between doctors who mostly talk to patients, and those who mostly perform procedures.

Also related, why we have a primary care shortage.

(Credit Medscape)

4/ usually we like to blame the @AmerMedicalAssn advisory body that suggests these RVU updates (which @CMSGov generally follows), called "The RUC"

There are 29 members: 24 are specialists and 5 represent primary care https://abs.twimg.com/emoji/v2/... draggable="false" alt="🧐" title="Gesicht mit Monokel" aria-label="Emoji: Gesicht mit Monokel">

(But I can& #39;t blame them today!) https://khn.org/news/ama-center-public-integrity/">https://khn.org/news/ama-...

5/ there have been calls to reform, or even abolish the RUC& #39;s influence on government rate setting (which then cascades down to all private payers too)

Here& #39;s one from @amprog https://www.americanprogress.org/issues/healthcare/reports/2018/07/13/453159/rethinking-the-ruc/">https://www.americanprogress.org/issues/he...

6/ but in this case, it was the RUC itself that recommended these reforms to increase relative value of "cognitive procedures"

I& #39;d love to know the inside story of those deliberations!

7/ the changes certainly won& #39;t equalize pay between specialties, but (if finalized) will give family physicians a 13% bump! (And also help rheumatology, oncology, endocrinology)

I sure hope the knives don& #39;t come out from those who will see some decrease from budget neurrality