They plan to argue, among other things, that the RUC has become increasingly arbitrary in its decisions, and that over time, this has led to a significant undervaluing of primary care services. They will also argue that the RUC is an illegal advisory committee to the CMS, Dr. Fischer said.
He said they plan to file the lawsuit July 15, with the goal of getting a court decision in time to influence the valuing of next year’s Medicare codes.
Congress Takes Notice. Dr. Fischer and Dr. Klepper aren’t alone in their criticism of the RUC. Rep. Jim McDermott (D-Wash.), a member of the House Ways and Means Committee, recently introduced legislation aimed at increasing the transparency and accountability of the RUC’s process.
Specifically, the bill, the Medicare Physician Payment Transparency and Assessment Act of 2011 (H.R. 1256), would require the CMS to consider the recommendations of independent, analytic contractors that would identify and analyze misvalued Medicare physician services. The bill would require the review of misvalued services to occur yearly.
AMA: RUC’s Okay. Despite the criticism, the AMA stands by the RUC and its treatment of primary care.
RUC chairwoman Dr. Levy, a gynecologist in Federal Way, Wash., said the panel has made a number of recommendations in recent years to the CMS that would favor primary care. And Medicare payments for primary care services have risen more than 20% since 2006, she said.
In addition, in some cases the RUC has advocated for coding changes that would benefit primary care, such as paying for telephone consultations and coordination of care functions, Dr. Levy noted, but those recommendations were not adopted by the CMS.
Dr. Levy added that the RUC’s role in regard to primary care has really been "overblown." She said private insurers play a much larger role in determining the income of primary care physicians.
Replacing the RUC would be a mistake, she cautioned. If the panel goes away, so does the physician expertise that it brings with it.
"The RUC is the physician’s voice," Dr. Levy said. "No one knows more about what’s involved in providing services to Medicare patients than the physicians who care for them."
Dr. Levy acknowledged that many physicians don’t understand the RUC. But regardless of the public perception, all medical specialties, including primary care, are very active participants in the RUC process, she said.
And the RUC process isn’t stagnant. Dr. Levy said the RUC is constantly evolving to ensure that what panel members review is data driven and fair across the entire fee schedule. In the last 2 years, the RUC took on the task of reviewing and identifying potentially misvalued services for the first time.
So far, the panel has identified more than 900 potentially overvalued services and recommended substantial redistributions in Medicare physician payments, she said.