Bill to Bust AMA RUC Monopoly

The American Medical Association/Specialty Society Relative Value Scale Update Committee’s (RUC) meets behind closed doors and has a monopoly on making recommendations to Medicare for physician payments. A new bill in Congress would require Medicare to have their own expert panel to oversee the valuation of physician services and correct distortions in the fee schedule.

Primary care physicians have long complained that they have been stiffed by specialty care members on the committee and have subsequently been underpaid by Centers for Medicare and Medicaid Services (CMS). They even went to federal court to force changes.

Now Jim McDermott, M.D., a Democrat from Washington has introduced H.R. 2545 to require the oversight. Dr. McDermott said, “Currently, the RUC, a committee of 31 physicians, conducts reviews in closed meetings and provides limited release of the minutes of its proceedings. It is unevenly weighted by procedural specialists over primary care doctors and relies heavily on anecdotal and self-serving survey evidence, rather than forensic data. This causes skewed fees for procedure-based services such as pathology, surgery and imaging, eroding pay to primary care physicians.”

“No other area of the Medicare program asks providers to play such an active role in setting their own payments, ” continued McDermott. “Medicare certainly needs clinical expertise in order to fairly set reimbursements, but an outside organization, whose members benefit from $70 billion in annual public spending, needs checks and balances. No matter how well-intentioned, structural biases are inevitable and we’re seeing that effect as new doctors flock toward specialty care and away from primary care.”

The bill is based on a recommendation from the nonpartisan Medicare Payment Advisory Committee.

The panel would be composed of members without any direct conflicts of interest and would include patient representatives. It would also be subject to the Federal Advisory Committee Act, which requires advisory bodies to hold open meetings and publish minutes. Under the bill, Medicare could continue to request work from the RUC, but the independent experts would both initiate such requests and review RUC’s work product.

Thomas Sullivan of Policy and Medicine, wrote on September 20, 2013 that it is unlikely that given the current makeup of congress this bill has much room for success, but is does contribute to the debate to reform the physician payment system, which in the future with the right plan could muster bipartisan support.

Govtrack.us gave the bill a 1% chance of getting past the Republican-controlled House Energy and Commerce Committee and 0% chance of being enacted. Only 11% of bills made it past committee and only about 3% were enacted in 2011–2013.