Don't Trash the RUC: Alternatives Are 'Bone-Chilling'

Gregory A. Hood, MD

Disclosures

August 12, 2013

In This Article

The RUC Provides an Essential Service

One may judge the Relative Value Scale Update Committee (RUC) from the outcomes of its recommendations. To do so is fair, because the purpose of the committee is to create its output. As such, it is fair to describe the RUC as too heavily weighted toward procedures and specialists.

Gregory Hood, MD

However, this does not alter the truth: The RUC provides an essential service. Distorting the work of the committee when proposing that a new system be put in place, as was done in a recent Washington Monthly article, is disingenuous and perilous. As the United States finds itself at a critical juncture of healthcare reform, some of the ideas advanced in that piece are potentially more damaging to healthcare, seniors, and physicians than the actions of the RUC have ever been.

As a primary care internist, the recommendations made by the Specialty Society RUC over the decades obviously interest me.

I've never been to a RUC meeting. Like everyone else who has not attended a RUC meeting (of which there are hundreds, in addition to committee members and staff at each meeting), I do not have direct knowledge of what transpires in the meetings.

The idea that doctors get to play William Shatner and "name your own price" on what is paid for services rendered is an asinine premise. If that were the case, how could this be reconciled with the recent admission by the Centers for Medicare & Medicaid (CMS) that physicians are ceasing to accept Medicare, or at least new Medicare patients, at an accelerating rate?

The issues of Medicare funding and reimbursement are extremely complex and difficult to understand, especially for journalists, for whom this is an assignment to write about and then move on. The amount of payments to physicians, as well as the structure and coding for services, have been adjusted over the years for several reasons, including sustainable growth rate (SGR) adjustments by Congress and changes by CMS to authorized codes for reimbursement, among many others.

Physicians are mandated into budget neutrality by rules that require any increased value (as ultimately decided by the government, not the RUC) to be balanced by offsetting reductions.

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