After much debate, the AAFP Board of Directors has decided that the Academy will continue to participate in the AMA/Specialty Society Relative Value Scale Update Committee (RUC) for now, while continuing to advocate that changes be made to the RUC from within.
"Our Board of Directors has determined that the AAFP will remain a participant in the RUC at present, but we will continue to frequently reassess our involvement," said AAFP President Glen Stream, M.D., M.B.I., of Spokane, Wash. "We believe, at this point, that this action will best serve our members and the millions of patients they serve."
The Board voted to stay in the RUC during a meeting in Washington last week. The decision was the result of a great deal of thought and deliberation during the past several months that took into account "the possible ramifications of staying or no longer participating in the RUC," according to Stream.
As part of the deliberation process, the AAFP met with outside policy and thought leaders and researchers to discuss the implications of remaining in or leaving the RUC. In addition, Academy leaders talked with AAFP chapter executives.
- The AAFP has decided to continue to participate in the AMA/Specialty Society Relative Value Scale Update Committee (RUC) for now.
- However, the AAFP plans to frequently reassess its involvement in the RUC and will continue to strongly advocate that necessary changes be made to the RUC.
- In addition, the AAFP is aggressively exploring other methods of providing data to support higher value for primary care services and will share this data with CMS when it is available.
The RUC acts as an expert panel and makes recommendations to CMS on the relative values of CPT codes. Many family physicians and the AAFP have expressed a concern that the actions of the RUC are biased toward subspecialist procedures rather than evaluation and management services, leading to an undervaluation of primary care services.
In a June letter to the RUC, the AAFP asked the committee to make six key changes to the RUC's composition.
In response(www.amednews.com), in February, the RUC added a rotating seat for primary care instead of the four additional primary care seats for which the Academy had asked. In addition, the committee added a seat for the American Geriatrics Society and promised more transparency. However, the RUC failed to eliminate the current three rotating subspecialty seats, and it will not add three new seats for external representatives such as consumers, employers, and health systems and plans. In addition, the RUC has agreed to implement only partial voting transparency, not the full transparency the AAFP requested, according to Stream.
"Our Board has made it clear that the AAFP, and our RUC team, will continue to advocate strongly for what we believe are the necessary changes to the RUC," said Stream. "Perhaps in time, the RUC will realize the importance of a greater level of transparency to those who vote and the value of additional external representatives as it relates to their expertise and their positive impact on the culture of a group such as the RUC."
In the meantime, Stream said the AAFP is aggressively exploring other methods of finding data to support several initiatives:
- higher physician work and practice expense values for services provided by family physicians and other primary care physicians in a fee-for-service (FFS) system of payment;
- identification of the physician work and practice expense values for services that are overvalued in the current resource-based relative value scale (RBRVS) system of payment;
- identification of the inequity in valuing families of codes, especially as it relates to the services of primary care physicians as compared with those that are more procedural in nature; and
- identification of a potential methodology for the coding and payment of multiple primary care services provided at the same time of services, especially those relating to evaluation and management of patients with acute, chronic and preventive health care needs.
"While we intend to present such data to the RUC as appropriate, we also will submit it directly to CMS on a regular basis as it considers the Medicare Physician Payment Rule annually," said Stream. "No longer will the RUC be the only avenue for seeking to address the inequities of the current RBRVS system of FFS payment. In fact, over time, it is highly likely that the RUC will be but one of a much larger number of avenues for achieving payment reform leading to different and better payment for primary care services (including FFS) that are essential to a health care system meant to improve the quality and cost-efficiency of care to the American people."
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