The RUC, seen by many as vaguely mysterious – but very influential – advisors to Medicare on the value of physician services, is trying to be more open about its process.
Formally known as the Relative Value Scale Update Committee, the RUC will begin posting votes totals for each CPT code it considers and publishing its meeting minutes, starting in November. It also plans to publicize its meeting more widely.
According to the American Medical Association, which operates the committee jointly with the medical specialty societies, the RUC is already transparent in its operations with more than 300 individuals attending each of its meetings. That said, the panel often has been criticized as being secretive.
Dr. Barbara Levy, the RUC chairwoman, said that, over her entire time on the panel, she has never denied a request for an individual to attend a meeting. However, she added, those wishing to attend a RUC meeting must register. The group does not employ a completely open meeting process, as a way to protect its expert members from lobbying by groups or companies with a stake in how the codes are valued.
The RUC also has a confidentiality policy that bars its members and meeting attendees from publicizing the specifics of the panel’s discussions. This policy is to protect the "deliberative process," Dr. Levy said.
Dr. Yul D. Ejnes, an internist who serves as an alternate for the RUC primary care rotating seat, said that the panel has to strike a tough balance.
"The challenge for the RUC is to try to respond to all the concerns regarding transparency and accountability, while at the same time allowing the RUC to remain an effective body," he said.
As a new member to the RUC, Dr. Ejnes said he was struck by the fact that, before he got to know the individuals on the panel, he couldn’t tell which specialty they represented based on their comments.
RUC members are not there to "protect their own" specialty, Dr. Ejnes said.
Not everyone, though, is impressed by the panel’s efforts. Dr. Paul M. Fischer, a family physician in Augusta, Ga., who is part of an effort to replace the RUC, said the changes are simply "window dressing" that will not do anything to change the fundamental structure of the panel or its bias toward procedural specialties. Dr. Fischer previously filed an unsuccessful lawsuit against the RUC, claiming that it violates the Federal Advisory Committee Act.
The RUC also voted to make other changes, including updating its methodology on physician surveys.
The panel is increasing the minimum number of respondents required for each survey of commonly performed CPT codes. For instance, for physician services that are performed more than 1 million times each year among Medicare patients, at least 75 physicians must complete the survey. At least 50 physicians must be surveyed if the services are performed more than 100,000 times each year.
The panel also will begin using a centralized online survey process operated by the AMA, rather than relying on individual medical specialty societies to collect and report on survey results.
Part of the reason for the change is to make the survey process uniform across specialties, but it’s also an attempt to address the appearance of the "fox guarding the hen house" that comes from having specialty societies control the collection of data so important to determining how their members get paid, Dr. Levy said.
Although they haven’t had any problems with the old procedure, they wanted to avoid any appearance of conflict, she said.
"We’re consistently looking at our own processes and trying to improve them," Dr. Levy said.
What’s the RUC?
The Relative Value Scale Update Committee, better known as the RUC, is one of the most powerful panels in medicine that many physicians know nothing about.
The expert panel is run by the American Medical Association in conjunction with medical specialty societies and offers advice to the Centers for Medicare and Medicaid Services (CMS) on how to set the relative values for services performed by physicians, based on CPT code.
As a result, decisions made by the RUC have a major impact on how much physicians get paid both by Medicare and by private insurers, which often follow Medicare’s lead.
The CMS doesn’t accept all of the annual RUC recommendations, but the panel’s success rate is very high. The agency has adopted 95% of the RUC’s work relative value recommendations, according to the AMA.
The RUC is comprised of 31 members, 28 of whom vote. The bulk of the seats (25) are appointed by major national medical specialty societies.