AAFP Addresses RUC Subcommittee Regarding Changes the Academy Seeks

AAFP Board Chair: 'We've Presented Our Case'

September 26, 2011 04:15 pm Sheri Porter
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Goertz spoke with AAFP News Now shortly after his Sept. 22 presentation to the RUC subcommittee. He called the meeting "a positive exchange of information."

Story Highlights

  • The AAFP recently was invited to present its case for changes to the AMA/Specialty Society Relative Value Scale Update Committee, or RUC, which makes recommendations to CMS on the relative values of CPT codes.
  • AAFP Board Chair Roland Goertz, M.D., M.B.A., clarified for the RUC's administrative subcommittee five requests the Academy outlined in a June 10 letter to the committee.
  • A key element of the Academy's concerns about the RUC is that it consistently undervalues primary care.

"I was allowed to make a statement to clarify our request," said Goertz, adding that his 10-minute presentation was followed by a 50-minute question-and-answer session.

"Without telling the RUC exactly which path to take, I think we have made our case. Now it's up to them," said Goertz.

The RUC acts as an expert panel and makes recommendations to CMS on the relative values of CPT codes, which determine what physicians are paid for the services they deliver to patients. The Academy and other primary care physician organizations have made no secret of their belief that decisions made by the RUC favor subspecialist procedures rather than preventive care and chronic disease management services.

The AAFP's stance was summed up in that June letter to RUC Chair Barbara Levy, M.D., in which the Academy made five specific requests, asking the committee to

RUC Sparks Debate at 2011 Congress of Delegates

Many AAFP members have been quite vocal about their displeasure with the AMA/Specialty Society Relative Value Scale Update Committee, or RUC, which advises CMS on the valuation of CPT codes used to set physician payment. That frustration was unmistakable during the Academy's recent Congress of Delegates Sept. 12-14 in Orlando, Fla., where four separate resolutions were introduced asking the AAFP to withdraw from the RUC or find an alternative to CMS' current system of establishing payment for CPT codes.

Members debated both sides of the issue vigorously, with many urging that the Academy pull out of the RUC immediately, while others cautioned against acting too hastily.

Ultimately, all four resolutions were referred to the AAFP Board of Directors for further consideration.

  • add four true primary care seats -- one each for the AAFP, the American Academy of Pediatrics, the American College of Physicians and the American Osteopathic Association;
  • create three new seats to represent outside entities, such as consumers, employers, health systems and health plans;
  • add an additional seat to represent the specialty of geriatrics;
  • eliminate the three current rotating subspecialty seats when the current representatives' terms expire; and
  • implement voting transparency.

In addition to Goertz, three other Academy members took part in the recent Chicago meeting: Walter Larimore, M.D., of Monument, Colo.,who currently serves as the AAFP's representative to the RUC; Lee Mills, M.D., of Newton, Kan., who is the alternate representative, and Thomas Weida, M.D., of Hershey, Pa., who is the AAFP's RUC adviser.

None of the family physicians in attendance was able to provide any detail about the meeting's proceedings because of the RUC's stringent confidentiality agreements.

However, Goertz did say he was "cordially received" by the subcommittee members and that each of the Academy's five issues was addressed. "On every issue, there were questions related to clarifications, which I did my best to provide," said Goertz.

"When they excused me from the room, they began the serious deliberation of the five requests that we made of them," Goertz said, adding that even though he doesn't anticipate a formal answer to the requests immediately, "I do have every reason to believe that they will answer our request by the March (1, 2012) date we have given them."

Regarding the Academy's next move, Goertz said, "I don't believe that there are any other action steps that we can take at this time.

"We've done everything that is reasonable to make our case, and, at least to this point, we've been heard."

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Goertz spoke with AAFP News Now shortly after his Sept. 22 presentation to the RUC subcommittee. He called the meeting "a positive exchange of information."
"I was allowed to make a statement to clarify our request," said Goertz, adding that his 10- minute presentation was followed by a 50-minute question-and-answer session.

"Without telling the RUC exactly which path to take, I think we have made our case. Now it's up to them," said Goertz.

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