A heart surgeon may receive far more money for their work than a general practitioner. This is due to the intricacies of medical billing, which affect not just the health care industry, but the level of care that you as a patient receive.
Medical billing depends on relative value units, or RVUs. These are the metrics that evaluate the time, complexity and skill of the work a doctor does. For decades, these RVUs have been the cornerstone of how physicians are paid.
RVUs are set by the American Medical Association, which relies heavily on an advisory board of 32 physicians and other healthcare professionals.
While the board's recommendations are not binding, it has led to criticism that physicians have a conflict of interest since they essentially recommend their own pay. It also raises concerns that the system drives doctors to become specialists so they will be paid more — which could leave little incentive for sharp medical minds to go into primary care.
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Some policymakers have spent years warning of these billing codes and skewed incentives, but the issue has received little attention due to its complexity and due to industry groups that are accustomed to how payments are set.
In 2013, the Washington Post ran an investigation that found the advisory board for the AMA repeatedly inflated the amount of time a physician needed to complete a procedure. IT also found the American Medical Association overwhelmingly accepted the board's recommendations.
