RUC adds 2 seats for primary care

An American Geriatrics Society representative and a primary care physician will join the 29-member board that helps the government set Medicare rates.

By Charles Fiegl amednews staff — Posted Feb. 13, 2012

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A panel of physicians that recommends payment changes for individual Medicare services will gain two additional seats devoted to representing primary care physicians, the American Medical Association announced on Feb. 1.

The American Geriatrics Society now will have a permanent seat on the AMA/Specialty Society Relative Value Update Committee, known as the RUC. Another rotating seat will go to an actively practicing primary care physician, said Barbara Levy, MD, the RUC's chair.

"Their experience will be particularly important as we continue to work on meeting the unique health needs of an aging population and improving care coordination for patients with chronic conditions such as heart disease and diabetes," Dr. Levy said.

The RUC will grow to 31 members with the addition of the two primary care positions. Family physicians have advocated for more of a presence on the board, which has representatives from a wide range of medical specialties.

The panel has recommended thousands of pay changes to the Centers for Medicare & Medicaid Services since 1992 for services that are deemed overvalued or undervalued. CMS has accepted the majority of the advice. Primary care critics of the board say it partially is responsible for a large and growing payment differential between specialists and primary care physicians. The Obama administration is the subject of a pending lawsuit designed to force a change to the RUC-advised process of updating Medicare relative values.

The American College of Physicians praised the move to add seats. "We believe that this change will help improve the accuracy and appropriateness of the relative value process," said Dr. Virginia L. Hood, the college's president.

But changes should not end at the RUC, Dr. Hood said. The health care industry needs to do a better job representing primary care interests and must establish mechanisms that reward quality and not just volume. For instance, existing payment models, such as fee-for-service, used by insurers do not recognize the work internists do to coordinate patient care, she said.

The American Academy of Family Physicians has been more vocal in calling for significant changes to the RUC, including more seats that represent primary care and a permanent seat for geriatric medicine. AAFP Executive Vice President and CEO Douglas E. Henley, MD, said the academy's board will review the newest changes to the RUC during a meeting in March. He noted that AAFP has asked for more changes, such as adding three new seats to represent consumers, employers and health plans. Dr. Henley said the academy would withhold commenting further on the initial changes until it sees how the RUC responds to the totality of its request.

Rewarding care coordination

American Geriatrics Society members are looking forward to joining the board on a permanent basis. The society believes it will add significant expertise on treating patients with multiple chronic conditions.

"We are deeply appreciative that AGS has been awarded a permanent seat on the RUC and thank the many volunteer leaders, staff and others who have contributed to this achievement," said Alan Lazar off, MD, the society's RUC adviser and a member of the RUC administrative subcommittee. "We are additionally pleased that the RUC has established a permanent rotating seat for a primary care physician."

The committee has been a strong advocate for care coordination and has worked to have CMS pay for more patient education services, telephone conversations and medication management, Dr. Levy said. The panel also has partnered with the CPT Editorial Panel to create a work group on chronic care coordination.

"This group will make more recommendations to CMS to help appropriately recognize physicians' work on care coordination and the prevention and maintenance of chronic diseases," Dr. Levy said. "These new members will be an asset as this effort continues and on all recommendations the RUC makes regarding the work physicians do to care for Medicare patients."

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Who sits on the RUC?

A representative from the American Geriatrics Society and a primary care physician will join 29 other physicians who sit on the AMA/Specialty Society Relative Value Update Committee. Here are the RUC members as of the end of 2011:

RUC Chair: Barbara Levy, MD

American Medical Association: Arthur Traugott, MD

CPT Editorial Panel: Albert Bothe, MD

Health Care Professional Advisory Committee: Anthony Hamm, DC

Practice Expense Subcommittee: Bill Moran Jr., MD

American Academy of Dermatology: Scott Collins, MD

American Academy of Family Physicians: Walt Larimore, MD

American Academy of Ophthalmology: George Williams, MD

American Academy of Orthopaedic Surgeons: Dale Blasier, MD

American Academy of Otolaryngology -- Head and Neck Surgery: Charles F. Koopmann Jr., MD

American Assn. of Neurological Surgeons: Gregory Przybylski, MD

American Academy of Neurology: Marc Raphaelson, MD

American Academy of Pediatrics: Joel Bradley Jr., MD

American College of Cardiology: James Blankenship, MD

American College of Chest Physicians: Scott Manaker, MD, PhD

American College of Emergency Physicians: Michael Bishop, MD

American College of Obstetricians and Gynecologists: Sandra B. Reed, MD

American College of Physicians: J. Leonard Lichtenfeld, MD

American College of Radiology: Bibb Allen Jr., MD

American College of Rheumatology: Timothy Laing, MD

American College of Surgeons: John O. Gage, MD

American Osteopathic Assn.: David F. Hitzeman, DO

American Psychiatric Assn.: Ronald Burd, MD

American Urological Assn.: William F. Gee, MD

American Society of Anesthesiologists: Brenda Lewis, DO

American Society of Plastic Surgeons: James C. Waldorf, MD

College of American Pathologists: J. Allan Tucker, MD

Society of Thoracic Surgeons: Peter Smith, MD

Society for Vascular Surgery: David C. Han, MD

Source: RUC Members 2011, American Medical Association (link)

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