Tag Archives: Brian Klepper

The RUC is Bad Medicine: It Has To Go

Brian Klepper

Published 8/12/13 in Medscape Business of Medicine

BK 711RUC Is a Deep Root of Our Healthcare Crisis

“One of the biggest mistakes we made…is that we took the RUC…back in 1992 and gave it to the AMA…It’s incredibly political, and it’s just human nature…the specialists that spend more money and have more time have a bigger impact.”[1]

This quote was from Tom Scully, former Administrator, under President George W. Bush, of the Centers for Medicare & Medicaid Services (CMS), previously the Health Care Financing Administration (HCFA). Scully was a panelist in a May 2012 Senate Finance Committee roundtable discussion by former HCFA/CMS Administrators and has become one of the RUC’s most outspoken critics.

He was explaining how the American Medical Association (AMA) Relative Value Scale Update Committee (RUC), a group that sought to help the government by overseeing a valuation process for medical services, came to dominate and distort the pricing used in Medicare, Medicaid, and commercial health plans.

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The Secretive Group Behind Medicare Reimbursements

Kate Pickert

Published 7/29/13 in Time Magazine’s Swampland

Earlier this month, the Washington Post published a blockbuster front-page story about a secretive committee that determines what Medicare pays physicians for their work. Part of the American Medical Association (AMA), the committee estimates the time and intensity of various doctor tasks, and the recommendations are plugged into a formula that sets Medicare reimbursements. The committee overestimates the time it takes to perform myriad medical procedures, which thereby increases the amount doctors can earn from Medicare. One gastroenterologist in the Post story would have to work 26 hours, according to the committee time estimates, to accomplish what he gets done in a typical workday.

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Why Aren’t Primary Care Physicians More Ticked off about the RUC? An Interview with Brian Klepper

Brandon Glenn

Published 4/30/13 in Medical Economics

If primary care physicians have a bigger enemy than the RUC, Brian Klepper, PhD, hasn’t heard about it.

The American Medical Association’s (AMA) Relative Value Scale Update Committee (RUC) is a 31-physician panel that wields enormous influence with the Centers for Medicare & Medicaid Services (CMS) in setting the relative values of medical procedures, which are then used to determine reimbursement levels. CMS has historically accepted about 90% of the panel’s recommendations.

Klepper is arguably the RUC’s most outspoken critic, thanks to his Replace the RUC blog. He charges that the RUC is subspecialist-dominated and as a result has played a prominent role in subjugating primary care – holding down primary care physicians’ salaries while contributing to the frantic, hamster-wheel-like feel of today’s primary care practices that are forced to pack each day with wall-to-wall 15-minute patient visits to turn a decent profit.

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The RUC’s Hollow Victory

Brian Klepper

Posted 5/18/12 on The Health Affairs Blog

On May 9th, William Nickerson, Senior Judge in the Southern Maryland Federal District Court, issued a 15 page ruling against the six Augusta, GA primary care physician plaintiffs who challenged HHS’ and CMS’ longstanding relationship with the American Medical Association’s Relative Value Scale Update Committee (RUC). The opinion did not weigh the substance of the case, but instead focused on a procedural provision in which Congress bars the judicial system from considering how the relative value units (RVUs) of medical services are determined. Judge Nickerson wrote:

Accepting as true that RUC plays a major role in the formation of the PFS [Physician Fee Schedule] and also accepting as true that this role unfairly skews the PFS toward certain medical professions and procedures, the Court, nonetheless, finds that Congress has precluded courts from reviewing, not only the final relative values and RVUs, but also the method by which those values and units are generated.

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Adding Seats: The RUC’s Sleight of Hand

Paul Fischer and Brian Klepper

Posted 3/14/12 on The Health Affairs Blog

©2012 Health Affairs by Project HOPE – The People-to-People Health Foundation, Inc.

On February 1, the American Medical Association’s Relat ive Value Scale Update Committee (RUC), Medicare’s primary advisor on physician payment, announced the addition of two seats: a permanent one for geriatrics and a rotating one for primary care. The American Geriatrics Society and the American College of Physicians praised the move as a step forward that will amplify the RUC’s appreciation of their physicians’ contributions.

But the RUC’s maneuvers are a cynical sleight of hand. They attempt to assuage charges of sub-specialty bias while continuing the RUC’s sub-specialty dominance. The additions reduce proceduralists’ share of votes from 27 of 29 (93 percent) to 27 of 31 (87 percent), hardly a power shift. Primary care comprises about 35 percent of US physicians, but cognitive medicine would have only 13 percent of the votes.

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Trusting Government: A Tale of Two Advisory Groups

David C. Kibbe and Brian Klepper

Posted 2/2/12 on the Health Affairs Blog

©2012 Health Affairs by Project HOPE – The People-to-People Health Foundation, Inc.

Americans increasingly distrust what they perceive as poorly run and conflicted government. Yet rarely can we see far enough inside the federal apparatus to examine what works and what doesn’t, or to inspect how good and bad decisions come to pass. Comparing the behaviors of two influential federal advisory bodies provides valuable lessons about how the mechanisms that drive government decisions can instill or diminish public trust.

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The AAFP’s Bold Valuation Initiative

Brian Klepper

First published 7/20/11 on Care & Cost

This morning, the American Academy of Family Physicians, the largest and “purest” of the major primary care societies – the American College of Physicians (ACP), the American Academy of Pediatrics (AAP) and the American Osteopathic Association (AOA) are all heavily influenced by sub-specialists – announced that it has convened a national task force charged with identifying new, better approaches to value primary care services.

This initiative is nationally significant for several reasons. By definition, it challenges the methodology used for nearly two decades by the American Medical Association’s Relative Value Scale Update Committee (AMA RUC), which has drastically under-valued primary care services while over-valuing many specialty services. By taking on this effort, it not only announces that the fruits of the AMA RUC’s labors are unacceptable, but also points out that the methodology the RUC uses to value medical services – this is founded on the Resource-Based Relative Value Scale (RBRVS) “input” taxonomy developed by William Hsaio’s team in the late 1980s – is incomplete and outdated. For example, the RUC’s methodology for calculating value doesn’t consider whether a service produced a worthwhile benefit to the patient or society, whether it was evidence-based or even necessary. More on this in a future article.

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