The Composition of The RVS Update Committee

Preface: Lately RUC, short for the Resource-Based Value Update Committee, has come under fire for favoring specialist pay over primary care pay. I have heard the side of the argument saying the AMA is somehow in collusion with CMS favoring specialists. This favoritism, it is said, is directly responsible for runaway health costs.

Here is how the AMA explains and justifies its position on RUC.

Annual updates to the physician work relative values are based on recommendations from a committee involving the AMA and national medical specialty societies. The AMA formed the AMA/Specialty Society Relative Value Scale Update Committee (RUC) to act as an expert panel in developing relative value recommendations to CMS.

The AMA established a process in the course of its activities to develop relative values for new or revised CPT codes. This process was established in the course of the AMA's normal activities and as a basis for exercising its First Amendment right to petition the Federal Government as part of its research and data collection activities, for monitoring economic trends and in connection and related to the CPT development process.

In addition, CMS is mandated to make appropriate adjustments to the new RBRVS in response to the Omnibus Budget Reconciliation Act of 1989 to account for changes in medical practice coding and new data and procedures. The purpose of the RUC process is to provide recommendations to CMS for use in annual updates to the new Medicare RVS.

There have been numerous changes and improvements to the payment system since 1992, many initiated by the RUC, but the principal role and purpose of the RUC remains to provide final RVS update recommendations to CMS. The RUC is a unique committee that involves the AMA and the specialty societies and gives physicians a voice in shaping Medicare relative values. The AMA is responsible for staffing the RUC and providing logistical support for the RUC meetings. Neither the RUC nor any of its subcommittees or workgroups have the authority to direct the AMA to conduct work projects, products or research.

Composition of the RVS Update Committee (RUC)

The RUC represents the entire medical profession, with 23 of its 29 members appointed by major national medical specialty societies including those recognized by the American Board of Medical Specialties, those with a large percentage of physicians in patient care, and those that account for high percentages of Medicare expenditures. Three seats rotate on a two-year basis, with two reserved for an internal medicine subspecialty and one for any other specialty. The RUC Chair, the Co-Chair of the RUC Health Care Professionals Advisory Committee Review Board, and representatives of the AMA, American Osteopathic Association, the Chair of the Practice Expense Review Committee and CPT Editorial Panel hold the remaining six seats. The AMA Board of Trustees selects the RUC chair and also the AMA representative to the RUC. The individual RUC members are nominated by the specialty societies and are approved by the AMA.

Chair
American Medical Association Representative
CPT Editorial Panel Representative
American Osteopathic Association Representative

Health Care Professionals Advisory Committee Representative
Practice Expense Review Committee Representative

• Anesthesiology
• Cardiology
• Colon and Rectal Surgery*
• Dermatology
• Emergency Medicine
• Family Medicine
• General Surgery
• Internal Medicine
• Nephrology*
• Neurology
• Neurosurgery
• Obstetrics/Gynecology
• Ophthalmology
• Orthopaedic Surgery
• Otolaryngology
• Pathology
• Pediatrics
• Plastic Surgery
• Pulmonary Medicine*
• Psychiatry
• Radiology
• Thoracic Surgery
• Urology
* Indicates rotating seat