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The RUC makes recommendations to CMS on how to value a physician's work

Dec. 6, 2024 (ACP) -- In a major victory for internal medicine, advocacy by the �ܼ�����ˮ��̳ helped convince the governing body of the American Medical Association to study how it makes recommendations to the Centers for Medicare & Medicaid Services regarding Relative Value Units (RVUs).

“This truly is a big deal,” said Dr. Sue S. Bornstein, chair of the ACP delegation to the AMA, who attended the AMA November 2024 interim meeting of its House of Delegates. “This is a win for us.”

At issue: Should the AMA try to reform the workings of its Relative Value Scale Update Committee (RUC), a volunteer group of medical professionals who make recommendations to CMS on how to value a physician's work?

About a year ago, ACP introduced a resolution at an AMA meeting calling for the modernization of the RUC. “The resolution was very vigorously debated, and it was referred to the AMA Board of Trustees for a report,” Bornstein said. “That report came back, and it wasn't satisfactory to us because we felt that they really were advocating for the status quo.”

The RUC system of making recommendations regarding RVUs needs improvement, according to Bornstein, because it relies on lengthy surveys about the time, intensity and complexity of the work that physicians conduct with their patients. “It's cumbersome and probably inaccurate because we're relying on people's memories,” she said.

It is especially difficult to measure the value of the work of internal medicine physicians who may, for example, have to take care of an elderly person who has five different chronic illnesses and takes 10 different medications, Bornstein explained. “Specifically, we wanted the AMA to agree to a pilot project where they looked at alternate sources of data, such as time reports from electronic health records,” she said.

The AMA House of Delegates ultimately supported an amendment to the Board of Trustees report to have the AMA conduct a study on whether the data-gathering process would be improved by using existing data from large companies and health systems, such as Epic, Cerner and Kaiser. “We put a whole lot of our firepower into this one issue, and we're pleased with how it seems to have come out,” Bornstein noted.

On another front, ACP is pleased that the AMA is an ally in advocacy for a Medicare payment fix. Both organizations support the bipartisan Medicare Patient Access and Practice Stabilization Act of 2024, which would avert the 2025 2.8 percent cut in Medicare payments and provide a 1.8 percent inflationary update.

“Congress must prioritize passing this legislation during the lame-duck session,” AMA President Dr. Bruce A. Scott said during the meeting's opening session. “Make no mistake, this is going to be an uphill battle. But I believe that with the unified voice of physicians from across the country -- from every state and specialty -- together, we can fix it. We can fix Medicare now.”

At the AMA Internal Medicine Caucus, Dr. Isaac O. Opole, ACP president, told attendees, “We will be ramping up our advocacy as Congress returns to work for their lame-duck session.”

He added: “Our work with the AMA and other medical societies is incredibly important. Together, our influence multiplies exponentially.”

Back to the December 6, 2024 issue of ACP Advocate