Independent Payment Advisory Board composed of 15 philosopher kings who will rule over U.S. health care. there is already a similar advisory board. It existed for decades. Medicare contracted the AMA for advise about payments. The AMA formed an advisory board, specifically for this purpose. As I recall, it consists of close to 30 persons, some 8 or 9 out of 10 of them are specialists, not primary care. Medicare, for the most part, rubber stamps their recommendations.
Back in the mid 80's some researchers at Harvard developed the Relative Value Unit (RVU) concept, which is an estimate of the amount of work and level of skill required by every conceivable healthcare service. The thing is very scientific. Medicare accepted the idea, and appointed a bunch of AMA bureaucrat docs to assign the number of those RVU's to each service. In other words, every service, for decades, was compensated in the amount that a bunch of guys and gals on that advisory board decided it was worth.
Later, other insurers started using Medicare fee levels as a guideline. This, basically, is what molded healthcare in this country over the past many decades. The near destruction of primary care medicine is one of their proud accomplishments.
Another huge formative influence was the misallocation of funding between parts A and B. This is the reason why hospitals are taking over everything, and costs are rising.
Of course, for the government, the cure for the mess created by monumental stupid top down policy errors is to double the numbers of paper pushers. |
