AMA’s RUC panel draws more fire

Modern Healthcare - - NEWS - By An­dis Robeznieks

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.”

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