Terrific post by Happy Hospitalist on the ridiculous nature of proposed medical home reimbursement

Primary care and any thoughts of actually trying to do well by patients is again lost to the revenue politics coming from the RUC. As Happy illustrates, its basically a call for a Chronic Care Corps-- where primary care physicians are asked to volunteer to care for sick people.

Some highlights (refer to Happy's article for more details)

9.2 minutes per month per patient in physician time for a Tier 3 Medical Home

RUC recommends a work RVU per patient per month of 0.35 for a Tier 3 Medical Home. In essence, you are paid $86 an hour, and that's before you pay your over head. After overhead and taxes, you are lucky to take home $30 an hour

All I have to say is, these are the folks who created the mess, and their trying to create a system that is "cost neutral", that will pay for itself by not taking any money from their own specialties. It's paying for itself alright. By punching primary care in the face.

Again, the policy wonks seem to think they can legislate sickness to go away and continue to push procedures over care coordination and engagement. 9.2/month for very sick people is a joke-- I can't even keep my hair in control (and I have an army cut) in the time they're expecting a doc to serve as their patient's health quarterback.

The RUC is hastening the death of primary care-- soon however will rise new mechanisms to remove it from the stranglehold of the "insurance" shakedown racket.