Specialty Society Relative Value Scale Update Committee
Encyclopedia
The Specialty Society Relative Value Scale Update Committee or Relative Value Update Committee, (RUC, pronounced "ruck") is a private group of 29 mostly specialist physician
s who have made highly influential recommendations on how to value a physician's work when computing health care prices
in the United States' public health insurance
program Medicare
.
s making significantly higher sums of money than primary care physician
s.
With reference to the research of William Hsiao
and colleagues, the Omnibus Budget Reconciliation Act of 1989 was passed with the legislative intent of reducing the payment disparity between primary care and other specialties through use of the resource-based relative value scale
(RBRVS). However, RBRVS was never fully implemented, partially due to RUC.
(AMA) and medical specialist groups. The AMA sponsors RUC "both as an exercise of 'its First Amendment rights to petition the Federal Government' and for 'monitoring economic trends ... related to the CPT [Current Procedures and Terminology] development process".
RUC is highly influential because it de facto sets Medicare valuations of physician work relative value units
(RVUs) of Current Procedural Terminology
(CPT) codes. (The Centers for Medicare and Medicaid Services
(CMS) is the de jure work RVU determining body.) On average, physician work RVUs make up slightly more than half of the value in a Medicare payment. Historically, CMS has accepted RUC recommendations more than 90% of the time. Health economist Uwe Reinhardt
characterized the CMS as slavishly accepting RUC recommendations. The physician work RVU values accepted by CMS also influence private health insurance
reimbursement.
In 2002, a RUC update of values raised concerns that the process, which was initatied by medical speciality groups, unfairly cut primary care physician
pay.
In a 2010 Archives of Internal Medicine
publication written before the major health care reform legislation passed Congress—the Patient Protection and Affordable Care Act
(PPACA)—Federman et al. wrote:
The Independent Payment Advisory Board
passed in the PPACA. It could bypass RUC to cut payments to relatively highly compensated specialists, such as dermatologists.
Physician
A physician is a health care provider who practices the profession of medicine, which is concerned with promoting, maintaining or restoring human health through the study, diagnosis, and treatment of disease, injury and other physical and mental impairments...
s who have made highly influential recommendations on how to value a physician's work when computing health care prices
Health care prices
Unlike most markets for consumer services in the United States, the health care market generally lacks transparent market-based pricing. Patients are typically not able to comparison shop for medical services based on price, as medical service providers do not typically disclose prices prior to...
in the United States' public health insurance
Health insurance
Health insurance is insurance against the risk of incurring medical expenses among individuals. By estimating the overall risk of health care expenses among a targeted group, an insurer can develop a routine finance structure, such as a monthly premium or payroll tax, to ensure that money is...
program Medicare
Medicare (United States)
Medicare is a social insurance program administered by the United States government, providing health insurance coverage to people who are aged 65 and over; to those who are under 65 and are permanently physically disabled or who have a congenital physical disability; or to those who meet other...
.
Background
Before the 1992 implementation of the Medicare fee schedule, physician payments were made under the "usual, customary and reasonable" payment model (a "charge-based" payment system). Physician services were largely considered to be misvalued under this system, with evaluation and management services being undervalued and procedures overvalued. Third-party payers (public and private health insurance) advocated for an improved model to replace the UCR fees, which had been associated with stark examples of specialistSpecialty (medicine)
A specialty in medicine is a branch of medical science. After completing medical school, physicians or surgeons usually further their medical education in a specific specialty of medicine by completing a multiple year residency to become a medical specialist.-History of medical specialization:To...
s making significantly higher sums of money than primary care physician
Primary care physician
A primary care physician, or PCP, is a physician/medical doctor who provides both the first contact for a person with an undiagnosed health concern as well as continuing care of varied medical conditions, not limited by cause, organ system, or diagnosis....
s.
With reference to the research of William Hsiao
William Hsiao
William C. Hsiao an American economist, is the K.T. Li Professor of Economics at the Harvard School of Public Health in Boston, Massachusetts...
and colleagues, the Omnibus Budget Reconciliation Act of 1989 was passed with the legislative intent of reducing the payment disparity between primary care and other specialties through use of the resource-based relative value scale
Resource-Based Relative Value Scale
Resource-based relative value scale is a schema used to determine how much money medical providers should be paid. It is partially used by Medicare in the United States and by nearly all Health maintenance organizations ....
(RBRVS). However, RBRVS was never fully implemented, partially due to RUC.
Workings
RUC was established in 1991 by the American Medical AssociationAmerican Medical Association
The American Medical Association , founded in 1847 and incorporated in 1897, is the largest association of medical doctors and medical students in the United States.-Scope and operations:...
(AMA) and medical specialist groups. The AMA sponsors RUC "both as an exercise of 'its First Amendment rights to petition the Federal Government' and for 'monitoring economic trends ... related to the CPT [Current Procedures and Terminology] development process".
RUC is highly influential because it de facto sets Medicare valuations of physician work relative value units
Relative Value Units
Relative value units are a measure of value used in the Medicare reimbursement formula for physician services. RVUs are a part of the resource-based relative value scale .-Background:...
(RVUs) of Current Procedural Terminology
Current Procedural Terminology
The Current Procedural Terminology code set is maintained by the American Medical Association through the CPT Editorial Panel. The CPT code set describes medical, surgical, and diagnostic services and is designed to communicate uniform information about medical services and procedures among...
(CPT) codes. (The Centers for Medicare and Medicaid Services
Centers for Medicare and Medicaid Services
The Centers for Medicare & Medicaid Services , previously known as the Health Care Financing Administration , is a federal agency within the United States Department of Health and Human Services that administers the Medicare program and works in partnership with state governments to administer...
(CMS) is the de jure work RVU determining body.) On average, physician work RVUs make up slightly more than half of the value in a Medicare payment. Historically, CMS has accepted RUC recommendations more than 90% of the time. Health economist Uwe Reinhardt
Uwe Reinhardt
Uwe E. Reinhardt is a professor of political economy at Princeton University and holds several positions in the healthcare industry. Reinhardt is a prominent scholar in health care economics and a frequent speaker and author on subjects ranging from the war in Iraq to the future of Medicare.-...
characterized the CMS as slavishly accepting RUC recommendations. The physician work RVU values accepted by CMS also influence private health insurance
Health insurance in the United States
The term health insurance is commonly used in the United States to describe any program that helps pay for medical expenses, whether through privately purchased insurance, social insurance or a non-insurance social welfare program funded by the government...
reimbursement.
In 2002, a RUC update of values raised concerns that the process, which was initatied by medical speciality groups, unfairly cut primary care physician
Primary care physician
A primary care physician, or PCP, is a physician/medical doctor who provides both the first contact for a person with an undiagnosed health concern as well as continuing care of varied medical conditions, not limited by cause, organ system, or diagnosis....
pay.
In a 2010 Archives of Internal Medicine
Archives of Internal Medicine
The Archives of Internal Medicine is a peer-reviewed medical journal published twice a month by the American Medical Association. The Archives of Internal Medicine was established in 1908 and covers all aspects of internal medicine, including cardiovascular disease, geriatrics, infectious disease,...
publication written before the major health care reform legislation passed Congress—the Patient Protection and Affordable Care Act
Patient Protection and Affordable Care Act
The Patient Protection and Affordable Care Act is a United States federal statute signed into law by President Barack Obama on March 23, 2010. The law is the principal health care reform legislation of the 111th United States Congress...
(PPACA)—Federman et al. wrote:
The Independent Payment Advisory Board
Independent Payment Advisory Board
The Independent Payment Advisory Board, or IPAB, is a fifteen-member, unelected United States Government agency created in 2010 by sections 3403 and 10320 of the Patient Protection and Affordable Care Act which has the explicit task of reducing the rate of growth in Medicare without affecting...
passed in the PPACA. It could bypass RUC to cut payments to relatively highly compensated specialists, such as dermatologists.