The AMA’s Spin

Brian Klepper

In case you don’t believe the AMA takes challenges to its role as CMS’ sole advisor on medical procedure valuation seriously, check out this letter that was sent by 2009 RUC Chair William Rich MD and RUC Chair-Elect (now Chair) Barbara Levy MD to Roy Poses MD, then Associate Professor of Clinical Medicine at Brown University Medical School.

Dr. Poses is a long time crusader who writes at the always controversial and scrupulously factual Health Care Renewal. On a van carrying us both to the Aspen Health Forum campus in 2007, Roy asked if I knew about the RUC. I didn’t, but he explained the basics, and then I researched and learned more when I returned home. We’ve been on the same page on this issue since.

On January 9, 2009, Roy posted a piece called “What, The RUC? – A Prominent Health Care Policy Blog Leaves Some Important Things Out,” one of many posts he’s written about the RUC, this one taking issue with Princeton health economist Uwe Reinhardt’s characterization of the problem the RUC has created, and Dr. Reinhardt’s possible but undisclosed conflicts of interest.

On March 6th, Roy received the letter below, on AMA letterhead, from the RUC’s current and incoming Chair. The letter, now posted on the AMA website here, states:

We would like to take this opportunity to point out several blatant inaccuracies within your blog entry that severely misrepresent the nature and work of the AMA / Specialty Society RVS Update Committee (RUC). We request that your retract or correct the inaccurate statements within the aforementioned blog immediately.

It magnanimously explains that “the RUC has made several recommendations that positively benefit cognitive or non-procedural physician specialties,” then absolves itself from accountability in primary care’s current economic plight, noting that “CMS rejected the recommendations of the RUC to increase valuation for E&M services in 1997 to the level the RUC had recommended.”

Finally, it chastises Dr. Poses. “By attempting to drive a wedge between cognitive and procedural specialties you weaken the physician lobby and undermine its efforts to effect positive change for all physicians and patients.”

After receiving this letter yesterday, I dropped Roy a note and asked whether he had responded to it. He said he had.

I sent a brief email (after talking to my attorney) saying something to the effect that if they would point out any specific factual errors in my blog posts, I would consider them and fix anything erroneous.  I never got a response.

He then wrote a response that is posted here. Needless to say, his rebuttal is NOT posted on the AMA’s site.

See below for the full letter.