AMA fights back against article criticizing RUC

The American Medical Association has responded sharply to a July 20 Washington Post investigative article that found that the AMA/Specialty Society RVS Update Committee (RUC) has overvalued many procedures by overstating the amount of physicians' time required to perform them. Washington Monthly published a critical article about the RUC earlier this month, similarly charging that the RUC is essentially a secret cabal of specialty physicians that overvalues services and fixes prices.

The Post reporters counted the number of Medicare procedures that gastroenterologists, ophthalmologists, orthopedists and other specialists performed at surgery centers in Florida and Pennsylvania. They found that if the physicians had taken the amount of time estimated by the RUC to do each procedure, they would have had to work an average of more than 12 hours a day, when the surgery centers typically were open only 10 hours.

The reporters focused on colonoscopies, finding that total physician time to perform the procedure is more like 15-30 minutes per patient, far less than the 75 minutes estimated by the RUC. They quoted Dr. Robert Berenson, a researcher at the Urban Institute, who timed his own colonoscopy at 15 minutes. “It reminds me of the Marx Brothers line,” he said. “ 'Who are you going to believe, me or your own eyes?' ”

The Post article also reported that the RUC over the past decade has increased work values for procedures far more frequently than it has decreased them. It noted that unlike with other federal advisory committees, RUC meetings and documents are confidential. It quoted Tom Scully, Medicare chief under President George W. Bush, saying that having the AMA run the process of “fixing prices” for Medicare “was a fundamental mistake.”

The AMA issued a “fact sheet” Monday responding to the Post investigation, accusing the Post reporters of making false statements and ignoring information the AMA gave them. The AMA noted that physician payment is subject to budget neutrality rules requiring offsetting reductions when relative values are increased. It stressed that the RUC has worked “vigorously” to address “misvaluations,” and that values for 500 services have been decreased. The AMA challenged the Post's finding that gastroenterologists in some centers were performing more than 16 endoscopies a day, saying the actual average is 6-8. Finally, the AMA insisted that the RUC is “not a secretive body,” and that it has implemented processes to improve transparency. It said a Post reporter was invited to attend a RUC meeting.

The AMA may not need to worry much that the Post's findings will trigger a response from lawmakers. While there have been proposals to limit or eliminate the RUC's role in setting Medicare prices—including a 2011 bill sponsored by Rep. Jim McDermott (D-Wa.) to have the CMS create an independent council of advisors to set Medicare values—Congress is unlikely to take action on this explosive issue any time soon.

Follow Harris Meyer on Twitter: @MHHmeyer