A panel of physicians decides how Medicare should value various medical procedures. This meeting of the AMA committee took place in Chicago last fall. AMA
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In an effort to increase revenue for family doctors, the American Academy of Family Physicians is pushing for additional representation on a little-known committee that wields powerful influence over Medicare payments.

Dr. Lori Heim, board chair of the group that represents family doctors, said the academy sent a letter late last week to the American Medical Association/Specialty Society Relative Value Update Committee, or RUC, seeking four more seats on the panel specifically for primary care physicians, which she said would help even the playing field between family doctors and specialists.

Heim said there are currently just three primary care representatives among the 29 physicians on the RUC, a group that advises the Centers for Medicare & Medicaid Services (CMS) on the relative values of medical procedures. Family medicine groups have long said their lack of representation on the RUC has led the group to undervalue the work of family doctors while overvaluing procedures, imaging and tests performed by specialists. Primary care physicians provide more than 40 percent of Medicare-paid office visits.

Technically, the RUC simply recommends procedure values, but CMS accepts the RUC’s recommendations more than 90 percent of the time, which has led to criticism that the arrangement is a conflict of interest allowing physicians a key role in determining what Medicare pays them. The workings of the RUC and the controversy over its practices were detailed in an iWatch News piece last November.

The letter is the latest chapter in an ongoing dispute between family doctors and the RUC. In a press release, Heim said if implemented the changes “will help rebalance payment to primary care physicians and more accurately reward the complex and comprehensive care they provide to patients.” However, the letter represents a turnabout in tone from earlier this year, when Dr. Roland Goetz, the president of the AAFP, said its board was discussing dropping out of the RUC entirely, a move supported by vocal members, including the New Jersey Academy of Family Physicians.

Heim said the academy decided it would be more effective to try to change the RUC from within. “I think it is incumbent on the organization to come up with alternatives instead of just walking away,” Heim said, though she did not rule out leaving the RUC if the requests are not met. The letter to the RUC asked for a decision by March 1, 2012, Heim said. The next RUC meeting is from Sept. 22 to 25, at the Hyatt Regency in Chicago.

In addition to the four additional primary care seats, the family physicians’ group asked that the RUC add three seats for health care consumers, employer health plan purchasers and private insurers, and also requested that RUC votes no longer be anonymous, in order to add transparency to what has been a secretive process.

In an e-mail statement, Dr. Barbara Levy, the chair of the RUC, said the group had received the letter and “will review the changes suggested by the AAFP.” She declined to elaborate, or to address criticism of the committee.

Brian Klepper, a health care consultant and commentator who has spearheaded the movement against the RUC on his website Replace the RUC! is also pulling back from his call that primary care organizations leave the RUC, although he said he doubts additional primary care members will in itself change the group’s “corrosive impacts.”

Despite the softer tone by family physician groups, RUC watchers say the AAFP request is unlikely to be well received by medical specialists on the committee. Brian Whitman, the associate director of regulatory affairs at the American College of Cardiology, said he supports increased payments for primary care, but said the RUC is not the correct place to address the issue, and that primary care pay increases “should not come at the expense of specialists.”

Whitman added that he believes primary care doctors are wrong to blame the RUC for the payment disparity. “That’s oversimplifying at best and probably just wrong,” he said. “I think it is much more of a complex situation than the critics of the RUC would like to believe.”

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