AMA: The RUC Is Fair and Objective

American Medical Association


August 15, 2013

AMA-Convened Expert Panel Benefits Medicare

The Relative Value Scale Update Committee (RUC) provides Medicare with fair and objective advice on gauging the resource cost of physician work.

The future success of Medicare depends in part on accurately assessing the constant evolution of science and technology and its impact on patient care. The explosion in health care advances changes the work of physicians over time, so Medicare physician payments need to mirror the change.

However, no system for assigning payments to medical services can rely solely on well-intentioned government staff and paid consultants to gauge the hard work and resources that go along with being a skilled healer. Ultimately, there is no substitute for relying on input from experienced physicians when gauging how much time and resources go into one medical service compared with another. No one knows more about what is involved in providing services to Medicare patients than the physicians who care for them.

The need for physician input into government rulemaking has turned an American Medical Association-convened panel of expert physicians, known as the Relative Value Scale Update Committee, into an undeserving lightning rod for critics. Although everyone is free to respond to the government's call for public feedback on Medicare, only physicians are criticized for doing so in a manner so organized, thorough, and accurate that our recommendations often are accepted.

Medicare holds the advice of the 31 volunteer physicians who comprise the update committee in high regard because they apply an evidence-based approach that produces fair and objective recommendations. By tapping into the front-line knowledge of physicians, Medicare gains credible insights into the complexities of patient care, and at no cost to taxpayers. As Medicare's ultimate decision maker, the Centers for Medicare & Medicaid Services has a seat at the table during all of the committee's discussions, but it is not obligated to accept any of the committee's recommendations.

In recent years, the government has counted on the committee to spearhead an initiative to recommend adjustments to Medicare. When CMS' initial efforts to identify potentially misvalued services were unable to obtain reliable data from government contractors, physicians took on this important task.

Hard Work by Physician Experts

Working through the committee, more than 300 experts in medicine and research have focused on more than 1500 medical services. To date, the committee has reviewed about 1300 potentially misvalued services and recommended reductions or deletions to more than 750 services, freeing more than $2.5 billion in Medicare funding to be redistributed to primary care and other services.

Recommendations made by the update committee must follow Medicare's payment principles, which were established by economists at Harvard University and required by federal law and regulations. This is one of many factors beyond the control of the committee that contribute to the current income differentials between primary care and specialty medicine.


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