While actual payment rates for Medicare services are limited by congressional budget games, the relative values assigned to those services are carefully weighed based on the resources required to provide each service. You might be surprised about who can provide input to shape those values.
The Centers for Medicare & Medicaid Services (CMS) announced earlier this month in its 2015 Medicare Physician Fee Schedule proposed rule that the agency plans to solicit public comment on changes under consideration for rates of specific services beginning in 2016. But this isn’t the first opportunity the health care community has had to help guide decisions about service values.
Medicare’s regulatory process allows physicians, hospitals, home health agencies, nursing homes and others to provide input into the policies that determine their Medicare payment rates. In fact, all regulated professions and industries are able to submit comments on government regulations that affect their work and their livelihoods.
To make sure physicians have a say in this process, for over 20 years the AMA convened the Relative Value Scale Update Committee (RUC), a volunteer group of 31 physicians and health care professionals with input from 300 advisers and other experts who represent each sector of medicine. These physicians contribute their highly technical expertise about complex medical procedures and make recommendations that take into account such factors as the cost of supplies and equipment and the time required of physicians and nurses to provide those services.
This process allows physicians and other health care professionals to provide direct consultation to the government, helping to meet the changing needs of medicine and facilitating speedier inclusion of updated medical techniques in the Medicare fee schedule.
CMS itself has recognized the value of receiving insight directly from members of the medical profession.
“For many codes, the surveys conducted by specialty societies as part of the RUC process are the best data that we have regarding the time and intensity of work,” the agency stated in the 2015 Medicare Physician Fee Schedule proposed rule. “The RUC determines the criteria and the methodology for those surveys. It also reviews the survey results. This process allows for development of survey data that are more reliable and comparable across specialties and services than would be possible without having the RUC at the center of the survey vetting process.”
“In addition, the debate and discussion of the services at the RUC meetings … provides a good understanding of what the service entails and how it compares to other services in the family and to services furnished by other specialties,” CMS said.
In recent years, the committee has evaluated more than 1,700 medical services accounting for $38 billion in Medicare spending. The committee has recommended reductions or deletions for 934 services, resulting in a redistribution of more than $3 billion within the Medicare program.
“Medicine is a profession with a heart. The RUC has allowed me to be my patients’ advocate,” said Doug Leahy, MD, a primary care physician and a RUC participant. “There is no group who does a better job to get it right and I am very honored to be part of the process.”
