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The RUC’s Record: Backing Primary Care



June 24th, 2009

Editor’s Note: Dr. Patchin wrote the blog post below in her official capacity as Chair of the Board of Trustees of the American Medical Association.

Health Affairs recently published an interview with Kerry Weems, former acting administrator of the Centers for Medicare and Medicaid Services. In the interview, inaccurate statements were made about the role of the AMA/Specialty Society RVS Update Committee (RUC), which advises CMS regarding the relative levels of reimbursement for different medical procedures performed by physicians.

Every time the RUC has been asked to review payments for E&M (evaluation and management) codes, the RUC has sent CMS recommendations that would lead to higher payments.

To clarify: The RUC makes recommendations to CMS, and then CMS makes its payment decisions. CMS has often disregarded recommendations related to primary care. In fact, under Kerry Weems’ tenure as CMS administrator, the RUC sent recommendations for new ways to describe and pay for:

· telephone calls
· team conferences
· management of care over a 90-day period for patients on blood-thinning medication.

CMS chose not to implement these recommendations, which would have directly helped primary care physicians. If implemented, these recommendations would have also helped move the nation toward the model of care we are working for with health reform this year, which emphasizes care coordination and disease management.

In 2008, the RUC unanimously supported Medicare’s medical home demo by developing payment methods specific to this project. At that time, Weems wrote to the RUC that “we express our sincere appreciation for the work of the RUC and its workgroup in supporting the Medical Home Demonstration project. …  CMS applauds the conscientious manner in which the RUC approached this very important task and the professionalism that marks your recommendations.”

While Weems complains that the resource-based relative value scale (RBRVS) is based on “inputs” — meaning the resources used to perform a health care service — instead of value, the fact is that CMS is required by law to base the payment system on resource costs. CMS established the rules for measuring resource costs, and the RUC process is based on these rules. The RUC does not have the power or authority to establish its recommendations on societal or market value.

Bottom line: the RUC makes recommendations, CMS makes payment decisions. Under the direction of Kerry Weems, CMS chose not to implement RUC recommendations on improving payments to primary care.

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2 Trackbacks for “The RUC’s Record: Backing Primary Care”

  1. Careful What You Wish For | The Incidental Economist
    August 21st, 2009 at 4:13 am
  2. Health Care. (united health care, universal health care) » Blog Archive » The RUCkus Continues: Former Medicare Administrator Calls the "RUC Process" "Incredibly Flawed," and the AMA Chair Says He’s "Inaccurate&q
    June 25th, 2009 at 9:05 pm

1 Response to “The RUC’s Record: Backing Primary Care”

  1. korrico Says:

    I take considerable exception to the comments of Mr. Weems regarding the RUC; particularly those putting the blame for the poor state of primary care at the feet of the RUC. I also find it appalling that he and other health policymakers continue to vilify specialty care, while at the same time deifying primary care. If you had a brain tumor or debilitating spinal disease that needed neurosurgery, would you be so quick to make the same statements? Would you not place a high value on the skill of your neurosurgeon? Would a primary care doctor be able to help you with these problems?

    Perhaps the reason medical students do not choose primary care is not simply because it is paid less, but because it is not as interesting and challenging as other medical specialties? Perhaps the reason why neurosurgeons and other specialists get paid more is because it takes them longer to train than primary care doctors. Perhaps it is also because they work far more hours and assume far greater risk than primary care doctors. Perhaps it is because their malpractice premiums are astronomical in comparison to primary care physicians.

    I would hope that in the future, Mr. Weems and other policymakers will think twice before dismissing the value of specialty care and those that provide it. We need all kinds of physicians in this country to take care of our every aging population, not just primary care physicians.

    Katie Orrico, Director Washington Office
    American Association of Neurological Surgeons/Congressof Neurological Surgeons

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