Barbara Levy, chair of the RUC, said: “The RUC is the voice of physicians – an independent panel of physicians from all medical specialties, including primary care, who make recommendations on the value of the work and resources involved in patient care.The AMA makes the data and rationale for each RUC recommendation publicly available.” But that data is only available for a price.
Others argue that because doctors are, in effect, helping set reimbursement rates, the committee’s influence on Medicare is a clear conflict of interest.
The argument is that the role of doctors has skewed payments in favor of specialists, while leaving family doctors behind. Six Georgia primary care physicians have filed a lawsuit seeking to end the cozy relationship between Medicare administrators and a committee of doctors that influences the fees physicians are paid by the federal health program for the elderly. District Court in Maryland, near CMS headquarters, which is located outside Baltimore.
This is one of a series of ongoing articles on how the government relies on doctors to help determine payments they receive as reimbursement for treating patients on Medicare.
Since 1991, an obscure committee of doctors has had a large hand in determining how much Medicare pays by making a case for the underlying value of their services.
The suit also alleges that the agencies violated the 2010 Affordable Care Act by failing to establish a process to validate Medicare procedure values.
“CMS has failed to realize that twenty years of AMA RUC control over the physician fee schedule has resulted in a process that is irrational, arbitrary, and absolutely destined to lead to the continued devastation of primary care,” the suit claims.
Ellen Griffith-Cohen, a CMS spokeswoman, declined to comment because the agency has a policy of not discussing pending litigation.
One former CMS official, however, said the agency has little choice but to rely on RUC to value procedures.
To date, three states — North Dakota, Idaho and Wyoming — have enacted the compact.