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Primary-care progress or stuck in a RUC?

The American Medical Association's Specialty Society Relative Value Scale Update Committee, also known as RUC, appears to be listening to its critics. But whether it's doing enough to hold on to its Medicare payment advisory role is another question.

On Feb. 1, the AMA released a statement from RUC Chairwoman Dr. Barbara Levy announcing that the panel was adding a representative from the American Geriatric Society and a rotating seat “for an actively practicing primary-care physician representative.” This closely resembles, but falls short of, recommendations made by the American Academy of Family Physicians for changing the makeup of the 29-member board (PDF).

The RUC has been slammed recently as a major cause for the compensation chasm that exists between primary-care and specialty physicians. Rather than just complain about it, the primary-care docs have been going on the offensive.

In a June 10 letter to Levy (PDF), the AAFP recommended that—in order for the RUC “to remain a credible entity” in its role as a CMS payment adviser—it needed to eliminate three seats reserved for a rotating set of subspecialty representatives. The letter said it should add four seats for representatives from the AAFP, American Academy of Pediatrics, American College of Physicians and American Osteopathic Association; add three “external” seats for representation by consumers, employers, health systems or health plans; and add a seat for geriatrics.

Last October, the RUC also made recommendations to the CMS suggesting that it start compensating for care coordination activities and telephone consults. The AAFP diplomatically referred to these recommendations as “a bridge” to a payment system that assigns a higher value to primary-care services, but Dr. Paul Fischer, founder of a 30-physician primary-care practice in Augusta, Ga., called them “pathetic,” adding that “They should be embarrassed about it.”

Fischer and his colleagues filed a lawsuit last August (PDF) alleging that HHS and the CMS are violating the Patient Protection and Affordable Care Act by using an “unchartered and unofficial” committee to determine the CMS fee schedule. A motion to dismiss (PDF) was filed Nov. 10, and an opposing motion was filed Jan. 18.

On another stage, the AAFP convened a task force looking at metrics that can be used to assign new values to primary services. The panel will report its findings to the AAFP board next month.

The statement by Levy seems to acknowledge the influence of these outside forces without acknowledging their existence.

“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,” Levy said in the statement. “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.”

Follow Andis Robeznieks on Twitter @MHARobeznieks.

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