AAFP Seeks Changes From the RUC

Stephanie Bourchard, Healthcare Finance News

6/14/11

LEAWOOD, KS – The American Academy of Family Physicians has long argued for more equity in payments for primary care services, but last week it became more outspoken. The national organization representing more than 100,000 family doctors sent a letter to the American Medical Association/Specialty Society Relative Value Scale Update Committee, most commonly known as RUC, demanding the committee make specific changes to its structure, processes and procedures.

Specifically, the AAFP is asking for:

• more seats for family medicine, general internal medicine and general pediatric medicine
• the addition of three new seats for external representatives such as consumers, employers and health plans
• a permanent seat for geriatric medicine
• the elimination of existing rotating subspecialty seats as the current representatives ‘term out’
• greater voting transparency on all RUC votes

“The drumbeat of changes in payment for primary care has been fairly longstanding,” said Lori Heim, MD, AAFP board chair. “When you end up with a payment structure that creates a payment for specialists that so far outstrips the value of primary care then I think that we have not got a system that truly values what the communities need.”

The RUC, formed by the AMA in 1991, is a group of 29 members (and 29 alternates) that advises the Centers for Medicare and Medicaid Services on the relative value of physician services, which determines how much physicians get paid.

The RUC has been criticized for many years as favoring specialists over primary care services.

A study done last year for the Medicare Payment Advisory Commission, or MedPAC, a Congressional watchdog, by staff from the Urban Institute and the Medical Group Management Association Center examined what doctors’ hourly pay rates would be if everyone were paid at Medicare rates only. Primary care doctors were at the bottom of the scale at $101.52 an hour; non-surgical, non-procedural specialties like psychiatry, rheumatology and emergency medicine came in at $134.43 an hour; and at the highest end of the scale, non-surgical, procedural specialties, such as cardiology, came in at $214.45.

“The problem is that the payment structure right now has created a huge differential between procedures versus cognitive care,” said Heim. “It’s that differential between them that’s created the impetus for medical students to go into subspecialties. So, we’re looking at what does the nation need in terms of a workforce? They need primary care. What does the literature and research say you need to do to create the balance? You need to decrease that differential because that’s what drives students. We need to look at how we pay primary care versus subspecialists, proceduralists, etc. How should cognitive services be valued differently?”

The AAFP has requested that the RUC respond to its recommendations by March 1, 2012. The RUC chair, Barbara Levy, MD, said, “The RUC has received and will review the changes suggested by AAFP.”

Independent from but related to its request to the RUC for changes, the AAFP has decided to create a task force to develop alternative methods for appropriately valuing the services provided by primary care physicians in the current fee-for-service model.

“I think it’s important . . . that we as an academy have said that it’s not enough to say that the RUC needs to change its process and structure,” said Heim. “We have actually committed resources and we formed a task force that is going to look at ‘OK, if we think that the RUC process doesn’t have the right methodology what would that look like?’ We’re convening a task force to evaluate that and to give recommendations to CMS on what other methodologies might be more appropriate for cognitive services. Primary care, obviously, is the leader in that.”

The task force will present its findings to the AAFP board in the next six to nine months.

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