Stifling Primary Care: Why Does CMS Still Support the RUC?

Brian Klepper, Paul Fischer and Kathleen Behan

First published 5/24/11 on the Health Affairs Blog.

Copyright ©2010 Health Affairs by Project HOPE – The People-to-People Health Foundation, Inc.

Last October, the Wall Street Journal ran a damning expose about the Relative Value Scale Update Committee (RUC), a secretive, specialist-dominated panel within the American Medical Association (AMA) that, for the past two decades, has been the Centers for Medicare and Medicaid Services’ (CMS’) primary advisor on valuation of medical services. Then, in December, Princeton economist Uwe Reinhardt followed up with a description of the RUC’s mechanics on the New York Times’ Economix blog. We saw this re-raising of the issue as an opportunity to undertake an action-oriented campaign against the RUC that builds on many professionals’ work – see here and here – over many years.

Continue reading “Stifling Primary Care: Why Does CMS Still Support the RUC?”

A Football Team Without a Front Line. That’s Medicine When (If) Primary Care Declares Independence

Wendy Lynch

First published 4/25/11 on the HCMS Group Blog

Behind closed doors trouble is brewing, and maybe it’s about time.

The situation has all the elements of a daytime drama: an exclusive cartel dictating price; a powerful committee with secret members and closed-door meetings trying to avoid exposure; members threatening mutiny; and media “spin” making it hard for the public to tell good guys from bad guys.

No, I am not referring to the NFL dispute between owners and players.  This is medicine.

The soap opera around the RUC (Relative-Value Update Committee) is real and the stakes couldn’t be higher: this little-known group influences the allocation of 2.5 trillion dollars (1) in healthcare spending each year.  But a closer look leads me to believe things are about to change.

Continue reading “A Football Team Without a Front Line. That’s Medicine When (If) Primary Care Declares Independence”

Facing Uncertainty: Why Primary Care Physicians Must Act Now

Brian Klepper

Over the past four months, the germ of a long overdue primary care uprising has sprouted and begun to flower. When David Kibbe and I first tried to think through how to neutralize the RUC’s terrible influence on American health care, we realized the first steps had to be the primary care community’s refusal to continue “enabling” the RUC – we meant this very much in the clinical sense – through its continued participation and complicity. When the game is rigged against you, there is no benefit in staying at the table.

Primary care societies would visibly and noisily abandon the RUC, with the understanding that quietly walking away would be counterproductive in the extreme. It should be a highly publicized exit, filled with righteous indignation and clarifying for the American public how the RUC’s actions and relationship with CMS have shafted patients, primary care physicians, and the people who pay for health care in America.

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A Primary Care Revolt

Richard Reece MD

First published 4/17/11 on MedInnovation Blog

An under-the-radar revolution is going on out there. It is a  revolt of primary care physicians against the AMA and CMS.  It is a request for parity with specialists.  It is a movement to replace how primary care practitioners are paid.

Why the revolt against the AMA and CMS? Because primary care doctors yearn to correct myths about primary care vis-à-vis specialists, and because they believe, by altering how the AMA and CMS pay doctors, health costs can be brought down, and primary care can be re-invigorated.  Health systems with a broad primary care base have lower costs. In the U.S., two-thirds of doctors are specialists, and one-third are in primary care, the reverse of most nations, which have 50% or lower costs.

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The RUC’s Defense

Brian Klepper

On Wednesday, 47 American medical specialty societies sent Rep. Jim McDermott (D-WA) a letter, with copies to all members of Congress, containing a detailed defense of the American Medical Association’s (AMA’s) Relative Value Scale Update Committee (RUC). For 20 years, the RUC has exclusively advised the Centers for Medicare and Medicaid Services (CMS) on physician procedure valuation and reimbursement. On its face, the letter responds to a seemingly minor piece of legislation introduced by Rep. McDermott, H.R. 1256, the Medicare Physician Payment Transparency and Assessment Act, that would require CMS to use processes outside the RUC to verify the RUC’s recommendations on medical services values.

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A Letter From America’s Medical Specialty Societies To Rep. McDermott (D-WA)

Brian’s Note: This letter, signed by 47 medical specialty societies, was sent Wednesday to Rep. Jim McDermott (D-WA), in response to his remarks before the House Ways & Means Committee, and to legislation he recently introduced, H.R. 1256, the Medicare Physician Payment Transparency and Assessment Act, that would require the Relative Value Scale Update Committee’s (RUC’s) recommendations to be validated using means that are external to the RUC.

This letter, representing virtually the entire medical specialty community, is a remarkable display of mobilized discipline and influence over a seemingly minor bill. Note that the arguments in it echo those made last week by Barbara Levy, MD, the RUC’s Chair, in an article published on Kaiser Health News (which I responded to here). It is also similar to a letter – see here – sent Tuesday by AMA CEO Michael Maves.

More on this shortly.


April 6, 2011

 

The Honorable Jim McDermott

U.S. House of Representatives

1035 Longworth House Office Building

Washington, D.C. 20515

 

Dear Rep. McDermott:

On behalf of our physician members who care for the full range of patient needs, the undersigned organizations write to respond to comments made during the March 15, 2011 hearing before the Ways and Means Subcommittee on Health to discuss the Medicare Payment Advisory Commission (MedPAC) March 2011 Report to the Congress: Medicare Payment Policy and to share concerns regarding the “Medicare Physician Payment Transparency and Assessment Act”, recently introduced by Representative Jim McDermott. Specifically, we want to address the apparent misconceptions about the composition and role of the American Medical Association’s Relative Value Update Committee (RUC).

The RUC is a multispecialty physician expert panel convened by the AMA with the support and cooperation of the physician and health care practitioner specialty societies who petition the government to provide a fair and equitable system of reimbursement for physician services. In addition to annual updates reflecting changes in Current Procedural Terminology (CPT), Section 1848(C)2(B) of the Omnibus Budget Reconciliation Act of 1990 requires the Centers for Medicare and Medicaid Services (CMS) to comprehensively review all relative values at least every five years and make any needed adjustments. The success of the RUC’s role in the annual updates led CMS to seek assistance from the RUC for each of the three Five-Year-Review processes. CMS participates in every RUC meeting. After each review is completed, the Secretary of Health and Human Services and CMS review the RUC’s recommendations and will then accept, modify, or reject any of the recommendations.

Continue reading “A Letter From America’s Medical Specialty Societies To Rep. McDermott (D-WA)”

A Growing Chorus On The RUC

Brian Klepper

Yesterday on Kaiser Health News, Barbara Levy MD, the Chair of the AMA’s Relative Value Scale Update Committee (or RUC), published a glowing defense of the RUC’s activities. Her article extols the work of the 29 physician volunteers who, “at no cost to taxpayers…generously volunteer their time,” “supported by advisers and staff from more than 100 national medical specialty societies and health care professional organizations.” She fails to mention that the physicians’ and organizations’ efforts to craft the RUC’s recommendations have direct financial benefit to the physicians, specialty societies and health care professional organizations whose representatives dominate the RUC proceedings.

Continue reading “A Growing Chorus On The RUC”