AAFP Board decides to continue participation in the RUC

The verdict is in. AAFP will continue participation in the AMA/Specialty Society Relative Value Scale Update Committee, better known as the RUC—at least for now.

During the March meeting of the AAFP Board of Directors, leaders evaluated the RUC’s response to a set of demands the Academy presented in June 2011 that would change the committee’s structure, process, and procedures. “We believe, at this point, that maintaining this policy continues to best serve our members and the millions of patients they serve,” AAFP Board Chair Roland Goertz, M.D., M.B.A., wrote in a March 2012 letter.

The RUC acts as an expert panel and makes recommendations to the Centers for Medicare and Medicaid Services on the relative values of CPT codes. AAFP and family physicians around the country have expressed concern that the actions of the RUC are biased toward subspecialist procedures rather than preventive care and chronic disease management, leading to an undervaluation of primary care services.

In June 2011, AAFP asked that the RUC add four “true” primary care seats, create three new seats to represent outside entities such as consumers and health plans, add an additional seat to represent geriatrics, eliminate three rotating subspecialty seats, and implement voting transparency.

RUC Chair Barbara Levy, M.D., responded in February 2012 that the RUC will “add additional primary care expertise and transparency measures to our structure and processes” by adding one new primary care rotating seat and a permanent seat for geriatrics, and by adopting a policy to record RUC votes and publish a total vote count after the publication of each Medicare physician payment schedule final rule.

Goertz responded in the March letter that the Academy is “deeply disappointed” that the majority of the requests were not accepted: only one primary care seat was added, the three rotating subspecialty seats were not eliminated, no seats for external representatives were added, and the voting transparency “falls well short of full transparency to those who vote.”

AAFP has pledged to advocate from within and publicly for the RUC to make necessary changes to its policies and procedures, continually reassess the Academy’s involvement on a yearly or more frequent basis, and explore other methods by which AAFP can invest in aggregating data to support initiatives that value primary care.

“While we intend to present such data to the RUC as appropriate, let me also make it clear that the AAFP intends to also submit such data directly to the Centers for Medicare and Medicaid Services on a regular basis as it considers the Medicare Physician Payment Rule annually,” Goertz wrote.

“No longer will the RUC be the only avenue for seeking to address the inequities in the current RBRVS system of FFS payment. In fact, over time, it is highly likely that the RUC will be but one of a much larger number of avenues for achieving payment reform leading to different and better payment for primary care services (including FFS) which are essential to a health care system meant to improve the quality and cost-efficiency of care to the American people.”