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Corruption With the RUC
The following piece demonstrates, in four by Richard Willner, VP, AMS (The Center for Peer Review Justice www.PeerReview.org Sham Peer Review Defense)
The following piece demonstrates, in four succinct and salient points, how physicians and patients in America stand to lose if the far-reaching and often self-serving powers of the American Medical Association are allowed to stand. The analysis presented here is a compelling call to action for all of us…
I. What is the RUC?
According to the American Medical Association (AMA) website regarding the RVS Update Committee, the AMA created the AMA/Specialty Society Relative Value Scale Update Committee (RUC) “to act as an expert panel in developing relative recommendations to CMS.” The Centers for Medicare and Medicaid Services (CMS) requires a medical services valuation committee to make recommendations. According to the AMA (in its toptenthings.pdf available on the AMA website), the RUC is “an independent group exercising its First Amendment Right to petition the federal government.” The AMA then proceeds to point out “the RUC is not an advisory committee to the Centers for Medicare and Medicaid Services” (CMS). CMS is entirely responsible for the RBRVS [Resource-Based Relative Value Scale]. All modifications to the RBRVS are made through ‘rulemaking’ and open to public comment.” This is one definition of the RUC, but alternative interpretations have surfaced.
According to an organization called “Replace the RUC!,” the RUC is a “secretive committee of the AMA that has been CMS’s primary source of physician payment data over the past 20 years.” [Paul M. Fischer, MD, Why Medical Specialists Should Want to End the Reign of the RUC, Aug. 16, 2011].
The result of the RUC’s recommendations to CMS over the past 20 years has resulted in increasing disparity between incomes for those providing primary care versus specialty services. This disparity resulted from the emphasis on procedure-based reimbursement, presumably favoring specialists.
II. How Does the RUC Affect My Practice, and Why Should I Care?
Society holds high esteem to those in the health profession. The 2010 Gallup Poll listed nurses as holding the highest level of honesty and ethics for the 11th year. Nurses received a response of 81% for “very high/high” ratings for honesty and ethical standards, while medical doctors scored 66% for the “very high/high” category. The lowest ratings in the poll went to lobbyist, car salespeople, and members of Congress. [Jeffrey M. Jones, Nurses Top Honesty and Ethics List for 11th Year, Dec. 03, 2010]. In a Gallup Poll from June 2009, “[n]early three-quarters of Americans (73%) say they are confident in doctors to recommend the right thing for reforming the U.S. healthcare system. That is significantly higher than public confidence extended to President Barack Obama . . ..” [Lydia Saad, On Healthcare, Americans Trust Physicians Over Politicians, June 17, 2009]. Many Americans falsely believe the AMA is the voice of physicians in America, but is this truly the case for your practice? There is an old adage that the person that cares most about your personal interests is you, so it would be foolhardy to consider the AMA to really be looking out for you, or your patients’ best interests in its dealings through the RUC with CMS.
Physicians must ensure that the respect entrusted by the public is protected in every aspect of healthcare, including the means by which recommendations are made to CMS regarding the valuation of services and procedures.
There are six family physicians in August, Georgia who have filed a legal complaint in an effort to seek non-monetary relief from “the negative effects brought about by CMS’ twenty year reliance on the . . . (RUC) for valuing doctors’ work.” [Brian Klepper and David Kibbe, CMS’ Opportunity: A Lawsuit Offers A Chance To Reform Physician Payment, Oct. 25, 2011].