This shawdowy group of physicians have a huge say in how doctors get paid. Look at the work they’ve done so far:

In 2008, the total value (unadjusted for budget neutrality or geography) for a 99214 is 2.53 RVUs. For a left heart catheterization (code 93510), the value is 40.54 RVUs, the bulk of which – 33.61 RVUs – is related to practice expenses. A family physician would have to do approximately 16 99214s to generate the same RVUs (and thus comparable Medicare income) as a cardiologist doing one 93510. Put another way, a cardiologist doing five 93510s would generate RVUs and Medicare income comparable to approximately 80 99214s. The typical family physician provides approximately 84 office visits a week1, most of which are likely lower levels of service than 99214.