RUC's Failings Spark Strong Testimony, Board Referral

Family physicians are getting tired of the status quo when it comes to CMS' continuing failure to appropriately value the evaluation and management, or E/M, services FPs and other primary care specialists provide. That fact was very much in evidence during the 2008 Congress of Delegates, when on Sept. 16, delegates referred two strongly worded resolutions on this issue to the AAFP Board of Directors -- adding more fuel to a long-smoldering fire.

According to many FPs who testified before the Reference Committee on Practice Enhancement here on Sept. 15, the lion's share of blame for the continuing shortfall lies squarely on the back of the AMA/Specialty Society Relative Value Scale Update Committee, or RUC, which makes recommendations to CMS for payment of physician services based on the resource-based relative value scale, or RBRVS, system.

The first of the two resolutions presented at this year's Congress calls for the Academy to "work to make the voting in the RUC proportional to the number of physicians that make up the constituent voting entities."

Failing that, the resolution adds, the AAFP should "disengage from the RUC and pursue other means to assign appropriate compensation for physician services."

The second measure is even more to the point, directing the AAFP to petition CMS to "develop an independent Relative Value Scale Advisory Board with membership representative of the current physician workforce providing care to Medicare recipients or mandate representative restructuring of the Relative Value Scale Update Committee."

After years of pressing for reform of the RUC and trying to attain a level of primary care representation on the committee that is proportionate to the primary care composition of the physician workforce, family medicine keeps coming up short of that goal, said proponents of the two resolutions.

In the words of New Jersey alternate delegate Mary Campagnolo, M.D., of Lumberton, "We're just not getting any food at this table; it's time to get up and move to a new table."

Of the more than two dozen voting physician members of the RUC, no more than a handful can be considered primary care physicians, and only one is a family physician.

Perhaps the most important aspect of the delegates' actions is that they serve to buttress ongoing AAFP efforts to remedy the RUC's shortcomings.

Indiana delegate Thomas Felger, M.D., of Granger, a member of the Commission on Practice Enhancement and the Academy's representative to the RUC, acknowledged his colleagues' frustration, but he sought to reassure them that the commission, together with the AAFP Board of Directors, is seeking workable solutions.

"We're looking at a whole new way of evaluating cognitive work," he said, "because that's where the RUC really fails."

Earlier this year, the commission proposed an overall strategy for tackling an admittedly complex RUC issue. At its March 2008 meeting, the AAFP Board approved that strategy and, in July, adopted a motion that the Academy would move forward by:

Some of those who addressed the reference committee pointed out the inadvisability of pulling out of the RUC precipitously, saying that absent a viable alternative for providing input on RBRVS-based payment, such an action stood to hurt FPs more than help them.

AAFP Director Roland Goertz, M.D., of Waco, Texas, recognized their concerns, testifying that although the Board has initiated discussions about the composition of the RUC and the payment inequities posed by the current configuration with members of the PCPCC, the Academy has no intention of rushing headlong into any situation that might prove untenable.

"After meeting with the other professional groups that are part of the PCPCC, they're very much against leaving the RUC at this time," said Goertz.