Dealing Strategically With the RUC to Boost Family Physician Payment

Lori Heim

First posted 7/13/11 on AAFP News Now

Brian’s Note: Regular readers will recall that in January, David C. Kibbe and I wrote a piece calling on America’s primary care societies to quit the RUC, the secretive, specialist-dominated AMA committee that has been the sole advisor to CMS on medical services valuation and reimbursement for the past 20 years. It is not unreasonable to assert that the RUC’s relationship with CMS is one of the deep roots of America’s health care cost crisis, an extraordinarily destructive mechanism that has had severely negative impacts on patients, purchasers and, of course, primary care physicians.

The AAFP initially rejected our suggestion, but has thought better of it over time. As Dr. Heim describes in this explanation to AAFP’s members, they issued a series of requests to the RUC: more primary care seats, a permanent seat for Gerontology, the sunsetting of some rotating sub-specialty seats, and the addition of some non-physicians (e.g., consumers, purchasers, health economists) to the committee. Obviously, the real question remaining is whether, if the RUC rejects these changes, the AAFP Board will have the will to walk.

All that said, her comments below are a good description of how they’re approaching this very complicated set of dynamics. 

Lori J. Heim, M.D., F.A.A.F.P.

Improving payment for the cognitive services we family physicians provide is, undoubtedly, the most crucial and challenging issue the Academy must resolve. The payment disparity between primary care and procedural specialties undermines every family physician who struggles to redesign and improve his or her practice in this economy, and it also drives medical students away from primary care.

The Academy has been working on many fronts to rectify this payment disparity. One important part of that effort is to make sure CMS receives recommendations on the relative values of CPT codes from experts who understand primary care. Unfortunately, that’s not happening now to the extent necessary. The only body making recommendations to CMS is the AMA/Specialty Society Relative Value Scale Update Committee, commonly called the RUC.

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