AMA’s RUC panel draws more fire

A report attacking the American Medical Association’s annual recommendations to the CMS on physician pay claims the association wildly overestimates the time it takes specialists to perform their work.

The report, an “expert voices” commentary published by the National Institute for Health Care Management, found that procedure times calculated by the AMA’s Relative Value Scale Update Committee (RUC) were 33% higher than actual observed times for 20 of 24 observed services.

The report author, Miriam Laugesen, an assistant professor of health policy and management at Columbia University, attacked the small sample sizes in the RUC’s survey methodology. “The first step to improving the quality of the evidence and strengthening the integrity of the RUC-centered update process would be to insist on surveys that meet scientific protocols,” she wrote.

Consumer advocates worry that the specialist-dominated AMA panel contributes to the shortage of primary-care physicians. A recent report from Public Citizen recommended that the RUC add representatives from consumers groups, health insurance plans, health systems and health economists.

But in a Sept. 18 Annals of Surgery report, University of Michigan researchers compared specialists’ procedure codes with primary-care doctors’ evaluation and management codes and concluded they “did not find evidence of a systematic higher valuation of physician work in procedure/test codes than in E/M codes in the CMS RVU system.”

“It is amazing to me how many people, including doctors, actually have no idea how payments per service are determined ... or how many incorrect or ill-informed assumptions are out there,” the report’s lead author, Dr. Kevin Kerber, said in a news release. “The RUC (is) not overtly setting payment rates higher for surgeons and proceduralists than primary doctors.”