• Stating Our Case to the RUC


    A few months ago, the AAFP sent a letter to the AMA/Specialty Society Relative Value Scale Update Committee, or RUC, calling on the committee to make changes in its structure, process and procedures.

    On Sept. 22, I had the opportunity to deliver our message in person.

    I was invited to speak to the RUC's administrative subcommittee in Chicago to clarify the requests made in that June 10 letter from then-AAFP Board Chair Lori Heim, M.D., of Vass, N.C., to RUC Chair Barbara Levy, M.D.

    Although the RUC's strict enforcement of its confidentiality agreements preclude me from describing the Sept. 22 meeting in detail, those who have been following this issue know where the Academy stands

    After my 10-minute presentation and a 50-minute question-and-answer session, so does the RUC subcommittee.

    For those who are unfamiliar with the RUC, here is the short version:

    The RUC is an expert panel that makes recommendations to CMS on the relative values of CPT codes. We believe the RUC process appears to be biased toward procedures and subspecialists rather than preventive care and chronic disease management, leading to an undervaluation of primary care services.

    At this point, only five of the committee's 29 members represent primary care. The effect of this bias unfortunately gets magnified beyond CMS because many insurance companies base their fee structures on Medicare.

    Dr. Heim's letter, which addressed this imbalance, 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 letter also requested that a decision from the RUC -- which is scheduled to meet again Jan. 26-29 -- regarding these changes be made by March 1, 2012.

    The subcommittee asked me questions related to all five of our requests, and I did my best to make our position clear. We've made our case. Now the ball is in their court.



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