Imagine needing a primary care provider and having to wait months to be seen. For millions of Washingtonians facing a critical shortage of PCPs, this isn’t a hypothetical, but a harsh reality.
As a primary care provider in an underserved Federally Qualified Health Center and a faculty member at Seattle University, I witness firsthand the consequences of a system that undervalues primary care. Unfortunately, our nation has made little progress in reducing health disparities over the past 20 years, according to the National Academies of Sciences, Engineering, and Medicine. While new technologies and treatments hold promise, the foundation of our health care system — primary care — is facing an unprecedented shortage.
At the heart of this crisis lies an influential but often overlooked entity — the Relative Value Scale Update Committee, established by the American Medical Association. Reforming the RUC could be a pivotal step in addressing the primary care workforce shortage and ensuring a more balanced and effective health care system. The 29-member RUC, established in 1991, advises the Centers for Medicare & Medicaid Services on how much health care providers should be reimbursed. The committee’s recommendations significantly impact how providers are reimbursed across various specialties, which has wide-ranging effects, even on private insurers.
Despite years of criticism from the Medicare Payment Advisory Commission, which advises Congress; the U.S. Government Accountability Office; and leading health policy experts, the RUC remains largely unchanged. The CMS relies heavily on the RUC’s recommendations but lacks the resources to conduct independent assessments. Increasing transparency and accountability in this process is long overdue.
The committee’s composition and decision-making processes harm our health care system. This is particularly true when it comes to PCPs, who provide comprehensive and continuous care. When determining Medicare reimbursement, the RUC disproportionately favors specialized care, leaving primary care providers undercompensated. This disparity discourages graduates from entering primary care fields, further straining our health care system’s ability to manage these critical issues.
The composition of the RUC is a major concern. The committee predominantly consists of specialists, with limited representation from primary care. This imbalance can lead to skewed recommendations that disproportionately favor procedures and interventions over holistic and continuous care. For instance, Medicare pays nearly the same amount to a clinician spending 30 seconds spraying liquid nitrogen on benign skin lesions as it does to a PCP spending 40 minutes with a patient with multiple, complex chronic conditions.
The impact of the RUC’s recommendations extends beyond Medicare. Many private insurers and state Medicaid programs use these recommendations as a benchmark for their own payment structures. As a result, the undervaluation of primary care services permeates the entire health care system, exacerbating the financial disincentives for entering primary care.
Beyond reforming the RUC, we must also promote payment models that reward value, not volume. Innovations like team-based care, bundled payments and quality-based reimbursement need long-term investment and policy support to succeed. These models can help realign incentives toward prevention, equity and better outcomes.
Investing in primary care is not just a matter of access. It is a matter of public health. Studies have consistently shown that robust primary care systems lead to better health outcomes, lower costs and reduced health disparities. By ensuring fair compensation, we can attract more clinicians to this vital field and build a more resilient health care system.
Reforming the RUC is critical to address these imbalances. It is time for policymakers, health care leaders and the public to recognize the crucial role of primary care and take decisive action to support and strengthen this cornerstone of our health care system. After 30 years of stagnation, we’re seeing a movement in Congress to examine these issues for the first time in years. This momentum must continue. I urge policymakers, health care leaders and the public to raise their voices and demand reform.
