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Dealing Strategically With the RUC to Boost Family Physician Payment
From its inception in 1991, the RUC has been dominated by procedural specialties whose representatives don't fully understand the complexity of the cognitive services we provide. They also have a financial interest in keeping the values for procedural services high.
Furthermore, although the RUC's methodology functions well when it comes to valuing one procedural code against a similar one, the methodology is flawed when comparing cognitive services with procedural services. The methodology also values our evaluation and management, or E&M, visits the same as the E&M visits of other specialties, not taking into account the multiple comorbidities we typically deal with in our patients.
As a result, the RUC often undervalues our cognitive services while leaving overvalued procedures alone -- an ongoing disaster for us in the Medicare fee-for-service system. Since fee-for-service will be at least a part of how we're paid for some time to come, this has to change.
- For years, the Academy has worked to reform the AMA/Specialty Society Relative Value Scale Update Committee, or RUC, to better value family physicians' services.
- In a recent letter to the RUC, the AAFP publicly outlined its grievances and set a March 1, 2012, deadline for the committee to respond.
- The AAFP Board also has created a diverse task force to explore the development of alternative methods for valuing primary care services.
But we shifted strategy and went very public with our concerns on June 10, when we sent the RUC a letter outlining the changes we want and, for the first time, setting a deadline for a decision -- March 1, 2012. We also issued a statement to the media about our letter.
In May, Board members discussed the situation in depth again. We were frustrated that our efforts weren't getting traction within the RUC, even though the public and policymakers increasingly understood the payment disparity's terrible implication for primary care. We knew that withdrawing from the RUC would be a dramatic gesture, but we kept coming back to this question: How would withdrawing advance our long-term strategy to improve payment for family physicians?
We knew that withdrawing would leave us with no way to keep pushing the RUC to change. For example, we were glad to support the bill recently introduced by Rep. Jim McDermott, D-Wash., that would require CMS to hire independent contractors to augment the RUC's work, but the bill would do nothing to change the RUC itself. Furthermore, although withdrawing from the RUC might focus more attention on the bill, we weren't optimistic about the bill's chances in the Republican-controlled House.
We carefully discussed all of this during our May meeting and took the additional step of consulting with outside policy leaders and researchers to get their input.
In the end, we decided that withdrawing without sending the RUC a formal request for change would not benefit AAFP members. Our June 10 letter was that formal request.
The Second Front
I am chairing that task force, and I'm glad to report that everyone we've asked to participate has responded with enthusiasm. All task force members have now been identified, and we'll announce their names shortly. We'll also hold our first meeting in August.
The task force will submit its recommendations to the AAFP Board within the next six to nine months, and we anticipate sharing them with CMS for its consideration. We've already met with the CMS administrator and his senior leadership team to discuss the task force, and they were very supportive of this direction. As a matter of fact, CMS observers will attend task force meetings in order to understand the thinking behind the recommendations when they receive them.
Sharing Your Opinion
One good way to share your thoughts is to discuss them with your chapter leaders, because chapters let us know what their members are saying about the RUC.
After the RUC responds to our letter, your Board will once again discuss our continued participation in that body. Your opinion will help us as we move forward.
Delegates Send Message to AAFP Leaders: Withdraw From the RUC