Tuesday, December 11, 2007

Coding, Physician Payment - The RUC (RVS Update Committee) Ruckus

RUC is short for RBVS Update Committee. Aticles have surfaced recently questioning whether the AMA has overloaded the RUC (whose members are not known) with subspecialists. Consequently, say critics, subspecialists may be rewarded at the expense of generalists.1-4

Here is what Dr. John Goodson, a Mass General Internist, says about the matter.

I am starting to believe that the distortions of physician reimbursement orchestrated behind the scenes by the shadowy RUC are one of the main reasons US health care is in such a mess. We had posted about the RUC, based on some important articles published this year that first brought its machinations to light (1, 2,3) 4

The story of the RUC often reminds me of conspiracy theories. They (we never really know who they are) determine the fate of the world (or at least the economy). The RUC has disproportionate power and has apparently taken a reasonable idea (RBRVS) and may have corrupted it.

I don’t have the knowledge to judge the merits of Goodson’s argument.
Here’s t the AMA says about the RUC’s composition:

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.

I do know this. Primary care is on the verge of collapse, and its practitioners are taking a series of steps to reinvent themselves - same day access, no phone trees when calls are made to the office, email consults, EMRs, and group visits. In high volume, low margin practices, these steps may not be enough if (and this is a very big if ) if reimbursement is skewed against primary care.

1. Bodenheimer T, Berenson RA, Rudolf P. The primary care-specialty income gap: why it matters. Ann Intern Med 2007; 146: 301-306..

2. Maxwell S, Zukcerman S, Berenson RA. Use of physicians' services under Medicare's resource-based payment system. N Engl J Med 2007; 356: 1853-1861.

3. Newhouse JP. Medicare spending on physicians - no easy fix in sight. N Engl J Med 2007; 356: 1883-1884.

4. Goodson JD. Unintended consequences of Resource-Based Relative Value Scale reimbursement. JAMA 2007; 298(19):2308-2310.


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