Academy Goes on Record Strongly Urging Changes in RUC Structure, Process

AAFP Task Force Will Work on Solutions for Better Pay for Primary Care

June 10, 2011 04:15 pm Sheri Porter

The AAFP took a bold step today toward ensuring that the health care services provided by primary care physicians -- and most importantly family physicians -- are appropriately valued.

In a strongly worded June 10 letter to Barbara Levy, M.D., chair of the AMA/Specialty Society Relative Value Scale Update Committee, or RUC, AAFP Board Chair Lori Heim, M.D., of Vass, N.C., called on the committee to make changes in the RUC's structure, process and procedures.

Specifically, the AAFP asked the RUC to

  • add four additional "true" primary care seats to the committee, including one each for 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;
  • include a seat for a representative of the specialty of geriatrics;
  • eliminate the three current rotating subspecialty seats when the current representatives' terms expire; and
  • implement voting transparency among the RUC representatives.

"We request a decision from the RUC regarding the implementation of these changes by March 1, 2012," said Heim, adding that the RUC should have ample time to consider and make decisions regarding the requests during its next two scheduled meetings.

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 preventive care and chronic disease management, leading to an undervaluation of primary care services.

"As you know, the AAFP has been concerned for some time about the composition of the RUC and the manner in which it conducts its business," said Heim in the letter. "We continue to believe that the RUC would benefit from additional primary care expertise and the perspectives of other stakeholders in the health care system."

Although the work of the RUC is very technical, additional representation from outside the physician realm would add a new and important perspective to discussion about the valuation of physician services, noted Heim.

In the same letter, the Academy said it intended to "create and fund a task force to review and make recommendations to the AAFP Board of Directors for an alternative methodology (or methodologies) to appropriately value evaluation and management services (provided) by family physicians and other primary care physicians." The task force will include experts in both health policy and research and will be chosen from professionals who work within the Academy, as well as from those outside the AAFP.

Heim pointed to a growing body of research that "suggests the complexity of evaluation and management services provided by primary care physicians today is different and likely more 'intense' than the same services provided by other specialties." The survey data that the RUC currently uses to value physician services should be complemented with other data sets so as to provide a more complete picture of how those physician services should be assessed across all physician specialties and subspecialties, said Heim.

The task force will make recommendations to the AAFP Board of Directors in the next six to nine months regarding alternative methodologies for valuing the health care services provided by primary care physicians.

In an interview with AAFP News Now, Heim made it clear that the Academy was taking a proactive stance on behalf of family physicians.

"Our evaluation of the RUC puts the committee on notice that it needs to change its structure and process because, currently, neither works for family medicine," said Heim. It isn't enough to simply say the current system is not working. "It's incumbent upon organizations like the AAFP to say 'This is what we need to replace the old methodology.'"

Heim also made it clear that the Academy has worked diligently -- albeit subtly -- during the past several years to encourage the RUC to make changes. When it became clear that a stronger approach was needed, however, AAFP leaders changed course. "Our frustration with the RUC is not new, and family physicians know this. What's different now is that, for the first time, the AAFP is formally calling on the RUC to implement changes," said Heim.

She acknowledged that some members have urged the Academy to withdraw from the RUC, but after much consideration and deliberation, the AAFP Board of Directors decided that taking such an action "would not be the best course for our members or for family medicine."

"However, we did want to make very public some prominent changes that we think will improve the RUC's function," said Heim. "We're calling on the committee to respond in a 'time certain.'"