Clarifying the role of RUC in healthcare payment decisions

In her op-ed “Healthcare payment should be retooled to focus on prevention” (ModernHealthcare.com, Aug. 19), while bemoaning the flaws of the Medicare payment system, Abigail Hardin, Ph.D., unfairly mischaracterizes the role of AMA/ Specialty Society Relative Value Scale Update Committee (RUC) with misleading claims about the committee’s scope and influence.

The truth is the RUC does not control Medicare’s payment system, nor does it allow physicians to set rates for medical services. The Centers for Medicare and Medicaid Services has the sole responsibility to set Medicare payment policy and its decisions are informed by a regulatory process that is open to recommendations from anyone. Yet only the RUC is singled out for criticism when making recommendations in a manner so organized, thorough, and accurate that those recommendations often are accepted.

Hardin also overlooked the critical role that the Health Care Professionals Advisory Committee (HCPAC) has played in developing relative value recommendations to CMS over the last 30 years. The HCPAC represents psychologists, physician assistants, chiropractors, nurses, occupational therapists, optometrists, physical therapists, podiatrists, audiologists, speech pathologists, social workers and registered dietitians. The HCPAC is principally responsible for developing relative value recommendations for codes that are reported by non-MD/DO professionals and in working with their physician colleagues in developing methodology and policy. The co-chair of the HCPAC also serves as a voting member of the RUC and I personally hold that important role today.

Richard Rausch

Co-chair of the RUC Health Care Professionals Advisory Committee Chicago

Editor’s note: Hardin’s op-ed stated: “The agency (CMS) makes the final determination about payments for services, but evidence shows they overwhelmingly accept the RUC’s recommendations.”