Medicare Physician Payment: The RUC’s Hollow Victory

Brian Klepper

Posted 5/18/12 on The Health Affairs Blog

On May 9th, William Nickerson, Senior Judge in the Southern Maryland Federal District Court, issued a 15 page ruling against the six Augusta, GA primary care physician plaintiffs who challenged HHS’ and CMS’ longstanding relationship with the American Medical Association’s Relative Value Scale Update Committee (RUC). The opinion did not weigh the substance of the case, but instead focused on a procedural provision in which Congress bars the judicial system from considering how the relative value units (RVUs) of medical services are determined. Judge Nickerson wrote:

Accepting as true that RUC plays a major role in the formation of the PFS [Physician Fee Schedule] and also accepting as true that this role unfairly skews the PFS toward certain medical professions and procedures, the Court, nonetheless, finds that Congress has precluded courts from reviewing, not only the final relative values and RVUs, but also the method by which those values and units are generated.

Continue reading “Medicare Physician Payment: The RUC’s Hollow Victory”

Why Primary Care Doctors Sued CMS over Its Reliance on the AMA’s RUC – and Why the RUC Should Be Changed or Replaced

Brian Klepper

Published in the February 2012 Issue of Medical Home News

L-R: Bob Clark, Becca Talley, Paul Fischer, Edwin Scott, Rob Suykerbuyk, Les Pollard - Click to Enlarge

Six Augusta, GA primary care physicians filed suit last August against the Centers for Medicare and Medicaid Services (CMS). They charged that for two decades the agency has relied primarily on the American Medical Association’s (AMA’s) Relative Value Scale Update Committee (RUC) to value medical services. But CMS has not required the RUC to adhere to the stringent management and reporting rules associated with the Federal Advisory Committee Act (FACA) that ensure that regulation is in the public rather than the special interest.

Continue reading “Why Primary Care Doctors Sued CMS over Its Reliance on the AMA’s RUC – and Why the RUC Should Be Changed or Replaced”