Medicare Reimbursement: How the AMA Relative Value Update Committee (RUC) Works and Who Is Involved

By Jane T. Dillion, MD, with Jenna W. Minton, Esq., AAO-HNS Staff, Health Policy  As an Academy member, you’ve probably seen frequent requests distributed in the e-News asking for volunteers for upcoming AMA Relative Value Update Committee (RUC) surveys of physician services. Many of you may have asked yourself what the RUC is and why the surveys are important. By providing the membership with some general background on this important process, we hope to encourage you to become an active participant in the annual RUC survey process. The AMA RUC was developed in response to the transition to a physician payment system based on the Resource-Based Relative Value Scale (RBRVS). The RUC is a multispecialty committee that provides clinical expertise and input on the resources required to provide physician services. The RUC submits recommendations to the Centers for Medicare and Medicaid Services (CMS) on an annual basis, which are used by CMS to develop relative values for physician services provided to Medicare beneficiaries. The RUC, in conjunction with the Current Procedural Terminology (CPT) Editorial Panel, has created a process where specialty societies can develop relative value recommendations for new and revised codes, and the RUC carefully reviews survey data presented by specialty societies to develop recommendations for consideration by CMS. CMS then issues final payment policies and values in the final Medicare Physician Fee Schedule rule, which is typically released in early November each year. The RUC is intended to represent the entire medical profession. Of its 31 members, 21 are appointed by major national medical specialty societies, including those recognized by the American Board of Medical Specialties; those with a large percentage of physicians in patient care; and those that account for high percentages of Medicare expenditures. Four seats rotate on a two-year basis, with two reserved for an internal medicine subspecialty, one for a primary care representative, and one for any other specialty. The RUC chair, the co-chair of the RUC Health Care Professionals Advisory Committee Review Board, and representatives of the AMA, American Osteopathic Association, the chair of the Practice Expense Review Committee, and chair CPT Editorial Panel hold the remaining six seats. The AMA Board of Trustees selects the RUC chair and the AMA representative to the RUC. The individual RUC members are nominated by the specialty societies and are approved by the AMA. The RUC currently includes the seats mentioned above and a representative and alternates for the following medical specialties: anesthesiology, cardiology, dermatology, emergency medicine, family medicine, general surgery, geriatrics, internal medicine, neurology, neurosurgery, obstetrics/gynecology, ophthalmology, orthopaedic surgery, otolaryngology, pathology, pediatrics, plastic surgery, primary care (rotating seat), pulmonary medicine (rotating seat), psychiatry, radiology, rheumatology (rotating seat), thoracic surgery, urology, and vascular surgery (rotating seat). The Academy actively participates in the RUC process and surveys codes for nearly every RUC meeting. Meetings take place three times a year during the winter, spring, and fall. The Academy’s current RUC representatives include RUC panel member Charles F. Koopmann, MD, and panel member alternate, Jane T. Dillon, MD. It is important to recognize that the RUC representatives for each specialty are not advocates for their specialty; rather they participate in an individual capacity and represent their own views and independent judgment while serving on the panel. The Academy also has RUC Advisors who are responsible for working with the Physician Payment Policy Workgroup (3P) and Academy staff to develop relative value recommendations and practice expense direct inputs for otolaryngology services that are presented to the RUC. The Academy RUC advisors are Wayne M. Koch, MD, and advisor alternate John T. Lanza, MD. As part of the Academy’s participation in the RUC, we often ask members to participate in surveys to help value CPT codes. The RUC team, outlined above, uses those survey responses to develop the recommendations for values and practice expenses that are presented to the RUC. The RUC hears presentations from all specialties interested in the service being reviewed and determines whether they agree with the proposed values, or whether the code needs further review. In the event the RUC does not agree with the value presented by the society, the code is sent to a facilitation committee to try to reach agreement on the most appropriate value for the service. Familiarity with the survey instrument and methodology is essential for accurate completion of a survey, which has important implications for Medicare reimbursement. Survey instruments are standardized across all specialties and random member samples are used to derive data for presentation to the RUC. In order to participate, respondents must be American physicians who are familiar with the service under review. Respondents must have supervised or performed the code being surveyed at least once during the past 12 months to complete a survey. For more background on the RUC Survey Process, members can access the following PowerPoint presentation on the AcademyU® website, located under Practice Management: www.entnet.org/educationandresearch/academyu.cfm. Members can also email any questions to healthpolicy@entnet.org. We hope this background is useful to members in better understanding the composition of the RUC as well as the importance of the survey process and its role in the valuation of medical services.