We at the American College of Physicians have been encouraged by several important announcements that have recently come from the RVS Update Committee (RUC). These announcements include improvements in the RUC’s primary care representation, increased transparency, and recognizing the need for stronger chronic care coordination.
These changes are directly in line with recommendations that ACP has made in recent months to the RUC. In an August 2011 letter to Dr. Barbara Levy, the RUC chair, ACP "urged that the RUC add representation from primary care and internal medicine subspecialties to reflect the growing need for expertise on the panel in the diagnosis, treatment, and management of chronic diseases. We see significant value in reconsidering the addition of a rotating primary care seat to the RUC, as was discussed during the 2007 deliberations of the RUC Administrative Subcommittee. We are also supportive of adding a permanent seat for geriatrics, as their growing patient population makes their perspective increasingly important."
By Dr. Virginia Hood
The RUC’s decision to expand its membership to include more representation of primary care and geriatrics through two new seats will help ensure that the RUC has the necessary expertise from physicians with the training, skills, and experience in comprehensive and longitudinal care of patients, especially those with complex illnesses. We believe that this change will help improve the accuracy and appropriateness of the relative value process. ACP also strongly supports the RUC’s efforts to improve recognition by Medicare of the value of physician services relating to the management of patients with complex illnesses. The added expertise of these two new physician members in caring for patients with multiple, chronic conditions should greatly assist in these efforts.
The RUC also has, importantly, announced increased transparency in their voting process. They will now publicly report the vote tally for all relative value recommendation votes. We at ACP have a long-standing policy that encourages greater transparency in decision making in our health care system. The RUC’s history of under-representation of primary care specialties, combined with their rules prohibiting the disclosure of votes on relative value recommendations, has, understandably, contributed to a lack of trust of the RUC process within the medical profession.
We understand that the closed voting process was established in order to protect RUC members from undue pressure and influence from the media, vendors, and specialty society interests. However, we also believe that the RUC needs to more clearly articulate its position on this issue and specifically state what it views as the potential ramifications of fully open voting. Therefore, we are encouraged that this initial step of revealing the vote tallies is a start to an ongoing process of improving the RUC transparency policies in an appropriate manner.
As part of these recent announcements, the RUC has also revealed that they have partnered with the Current Procedural Terminology Editorial Panel to create a new Chronic Care Coordination Workgroup. This group, according to Dr. Levy, will make more recommendations to CMS to help appropriately recognize physicians’ work on care coordination and the prevention and maintenance of chronic diseases.
ACP is pleased to be a participant in this new group, which is helping to develop new codes to address chronic care management and transitions of care. Countless studies have shown that care coordination, and appropriate recognition of this coordination, is vital to providing the best possible care for patients. The RUC’s efforts toward ensuring that CMS provide this recognition are a crucial step toward better aligning payment with appropriate care.
Finally, even though we welcome and applaud the RUC’s recent decisions, we at ACP will continue to advocate for comprehensive reform of the physician payment system. We need to ensure that physician services are compensated accurately and fairly, and that we continue to move toward models of payment that better align value with our patients’ needs.
Dr. Hood is president of the American College of Physicians and an internist and nephrologist from Burlington, Vt.