Delegates Send Message to AAFP Leaders: Withdraw From the RUC

Frustration about the AMA/ Specialty Society Relative Value Scale Update Committee, or RUC, was strongly evidenced by delegates at the AAFP's National Conference of Special Constituencies, or NCSC, here May 5-7, when they adopted a resolution calling on the AAFP to withdraw from the RUC.

The resolution, which was introduced during the Reference Committee on Advocacy hearing, calls on the AAFP to formally withdraw its representative from the RUC and to create a task force to identify alternative means of valuing primary care services. The resolution also asks the AAFP to make this task force's recommendations available to CMS and other payers.

The RUC acts as an expert panel and makes recommendations to CMS on the relative values of CPT codes. However, many family physicians are convinced those recommendations tend to undervalue primary care services.

"We came to the consensus that now is the time for us to go ahead and pull out of the RUC to delegitimize it -- to state publicly that it does not represent primary care, to state publicly that it does not represent 100,000 family physicians," said Robyn Liu, M.D., a new physician delegate from Tribune, Kan., and a co-author of the resolution, during testimony at the May 6 advocacy reference committee hearing.

"If you are not at the table, you are on the menu; but I feel like we are at the table, and we are still on the menu," said new physician delegate David Gilchrist, M.D., of Worcester, Mass.

The AAFP should use its growing political clout in Washington to make a statement by withdrawing from the RUC, said members. "We should speak up for ourselves," said Caroline Van Sant-Crowle, M.D., a women's delegate from New Port Richey, Fla.

Jay Lee, M.D., M.P.H., of Long Beach, Calif., the 2012 NCSC convener, expressed support for the "spirit of the resolution," but he had concerns about pulling out of the RUC without having some alternative.

"I think we have come a long way in terms of building our political capital in Washington," Lee said. "But I don't believe we have the political weight that we would need to be able to walk away from the RUC just yet."

Jose David, M.D., of Albany, N.Y., chair of the AAFP Commission on Membership and Member Services' Special Constituencies Subcommittee, also spoke in favor of the spirit of the resolution, but he, too, raised concerns about an immediate withdrawal from the RUC, saying the AMA could choose another primary care organization to serve on the body that does not represent the interests of family medicine.

The advocacy reference committee recommended that the resolution be adopted, also recommending that it be referred to the 2011 Congress of Delegates, instead of the usual trek to the AAFP Board of Directors for further determination.

Ryan Kauffman, M.D., of Bellefontaine, Ohio, expressed appreciation during the May 7 business session for the consideration the reference committee gave the resolution. However, he said, the Board currently is discussing the AAFP's involvement with the RUC. Instead of deferring the issue until the Congress of Delegates, it is important that members make their voices heard now, said Kauffman.

Joanna Bisgrove, M.D., a new physician delegate from Fitchburg, Wis., and co-author of the resolution, also urged delegates to send the resolution directly to the Board.

"If we leave it to the Congress, we'll be in a holding pattern," she said.

Theresa "Tess" Garcia, M.D., a minority representative from Grain Valley, Mo., expressed a different opinion, saying the resolution should first go to the Congress of Delegates. "I believe this resolution needs discussion, debate and, ultimately, adoption by the Congress of Delegates, so it will have more force going to the Board of Directors than just coming from the NCSC," said Garcia.

In the end, delegates adopted the resolution and sent it to the Board rather than the Congress of Delegates.

Delegates at the NCSC also adopted a number of other resolutions considered by the Reference Committee on Advocacy, including a substitute resolution that called on the AAFP to develop a patient-centered medical home pilot program for federally qualified community health centers, or FQHCs, and FQHC look-alikes using already available funding, strategic guidance and incentives.

A substitute resolution that directed the AAFP to "support the continued manufacturing of generic or compoundable medications even after a medication has been adopted by a pharmaceutical company through the Orphan Drug Act," also met with delegates' approval.

That resolution was introduced in response to a recent incident when a drug manufacturer dramatically increased the price of a medication used to prevent preterm births after the FDA granted it exclusive manufacturing rights under the Orphan Drug Act. "The drug went from $100 a month to $1,500 an injection per week," said Sarah Lamanuzzi, M.D., a women's delegate from Klamath Falls, Ore.

"We should come out for our patients to be able to continue to afford their treatment for whatever medical condition they have instead of supporting pharmaceutical companies getting richer," Lamanuzzi added.