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Another, even more powerful consequence of this system is that while the prices Medicare and private insurers pay for certain procedures have increasedโsometimes rapidlyโthe prices paid for other services have declined or stagnated. Thatโs largely because of basic flaws in the way the system is set up. For one, the RUC spends the vast majority of its time reviewing specialty procedures, which change more quickly as technology advances, rather than so-called โcognitiveโ services, like office visits, that primary care doctors and other generalists rely on for the bulk of their income. The result is that there are โa hundred ways to bill for removing varicose veins, and only one way to bill for an intermediate office visit,โ one former RUC member told me. For another, the RUC is dominated by specialists, who have a direct interest in setting the reimbursement rates for specialty procedures much higher than for general services.
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