The RVS Update Committee is one of the major reasons behind the flawed reimbursement system:
The RUC has 30 members (the chair only votes in case of a tie) with 23 of its members appointed by “national medical specialty societies.” Meetings are closed to outside observation except by invitation of the chair. Only 3 of the seats rotate on a 2-year basis. Other members have no term limits.“Seventeen of the permanent seats on the RUC are assigned to a variety of AMA-recognized specialty societies, including those that account for a very small portion of all professional Medicare billing, such as neurosurgery, plastic surgery, pathology, and otolaryngology. Proceedings are proprietary and therefore are not publicly available for review.
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The existence of RVS puts paid to any plausible claim that even “private” care in the US operates as any kind of free market.
The committee is where the power struggles are carried out by the central planners deciding who “deserves” how much.
It’s dissociation from underlying market forces shows itself as shortages: shortages of primary care physicians and psychiatrists (who will play the game) for example.
The only rational fee system for non-surgical services is time based. And it is a marketplace system only if the producer is free to set the fee and it is the customer who decides whether to accept it or not.
The thing with time based charges are that they give patients a much better metric to evaluate their docs charges by–he can decide whether he wants the 300$ an hour consultant or the 450$ an hour one.
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