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Thursday Oct 27, 2011

RUC's Failings Shouldn't Deter Student Interest in Family Medicine

 I recently had an opportunity to speak to more than 700 people at the Family Medicine Education Consortium(www.fmec.net) region meeting in Danvers, Mass. The audience included hundreds of family medicine educators, residents and  medical students.

My topic was the AMA/Specialty Society Relative Value Scale Update Committee, or RUC, the expert panel that makes recommendations to CMS on the relative values of CPT codes. For the 300 medical students in attendance, I delivered a key message about the RUC: Don't worry about it.

That idea might strike practicing family physicians as odd considering that a group of primary care docs have filed a federal lawsuit against CMS and HHS because of the agency's relationship with the RUC, and many of our members have asked the Academy to withdraw from the committee

But the RUC, and the problems it has created, should not be a barrier to student interest in family medicine. The RUC is a problem that we are working to fix, and it will be fixed in such a time that these young people's careers will not suffer negative, long-term effects.

So what's wrong with the RUC? For starters, only five of the RUC's 29 members potentially represent primary care. The committee's flawed structure has created a bias toward procedures and subspecialists rather than preventive care and chronic disease management. As a result, primary care services are undervalued by both Medicare and the private payers who base their fee structures on Medicare.

In June, the AAFP sent a letter to the RUC, calling on the committee to make changes in its structure, process and procedures. In September, Board Chair Roland Goertz, M.D., M.B.A., explained those requests in greater detail during a meeting of the RUC's administrative subcommittee in Chicago.

In short, the AAFP has made five specific requests of the RUC:

  • add four primary care seats to the RUC with one each from 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 a seat to represent the specialty of geriatrics;
  • eliminate the three current rotating subspecialty seats when the current representatives' terms expire; and
  • implement voting transparency.

The Academy also asked that a decision from the RUC regarding these changes be made by March 1, 2012.

Meanwhile, the AAFP has formed its own task force to review the methods used to evaluate health care services for Medicare and to make recommendations about how to properly value and pay for primary care physician services.

As for the aforementioned lawsuit, HHS and CMS must respond to the complaint by mid-November.

How exactly the process of valuing primary care services will change is uncertain, but it must change. The RUC, which has come under great scrutiny recently, cannot continue to function the way it does now. CMS has clearly acknowledged that primary care is undervalued, and the agency is working on solutions to address this problem. The AAFP is advocating for an alternate body to the RUC to provide input to CMS in the valuation of primary care services.

As I told the Family Medicine Education Consortium participants -- including third-year University of Pittsburgh medical student Diana Tucci, who is pictured above -- family medicine residents and medical students interested in family medicine should be confident that they are in the right place at the right time for a nation and a health care system that need family physicians more than ever.

I encourage students and residents to be engaged in this dialogue. The Academy has numerous opportunities for student and resident leadership. You can find out more here.

Posted at 12:03PM Oct 27, 2011 by Glen Stream, M.D., M.B.I.

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