I love this article, but then I am biased because I consider John Goodson a friend and colleague. Several other have linked to this article already – Unintended Consequences of Resource-Based Relative Value Scale Reimbursement

The American Medical Association (AMA) sponsors the resource-based relative value scale update committee (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.”17 Functionally, the RUC is the primary advisor to CMS for all work RVU decisions.

The RUC has 30 members (the chair only votes in case of a tie) with 23 of its members appointed by “national medical specialty societies.”17 Meetings are closed to outside observation except by invitation of the chair. Only 3 of the seats rotate on a 2-year basis. Other members have no term limits. Seventeen of the permanent seats on the RUC are assigned to a variety of AMA-recognized specialty societies including those that account for a very small portion of all professional Medicare billing, such as neurosurgery, plastic surgery, pathology, and otolaryngology. Proceedings are proprietary and therefore are not publicly available for review. Traditionally, more than 90% of the RUC’s recommendations are accepted and enacted by CMS (http://www.ama-assn.org/ama1/pub/upload/mm/380/rvs_booklet_07.pdf). As the catalog of billing opportunities expands, the total number and, importantly, the type of RVUs delivered each year have increased. From 1992 to 2002, the number of evaluation and management services as measured by RVUs increased 18% while the number of nonmajor procedures increased 21%, and the number of imaging services increased 70%.18 The resource-based relative value scale system “defies gravity”19 with the upward movement of nearly all codes. In 2006, based on RUC recommendations, CMS increased RVUs for 227 services and decreased them for 26.

The story of the RUC often reminds me of conspiracy theories. They (we never really know who they are) determine the fate of the world (or at least the economy). The RUC has disproportionate power and has apparently taken a reasonable idea (RBRVS) and corrupted it. If you want to know who to really blame, it is the RUC. I blame the AMA for developing a committee which does not represent the interest of overall health care, but rather the interests of subspecialties.

If you have access, please read John’s commentary. I have discussed this issue with John in the past, and he has taken the effort to really understand how the RUC impaired our reimbursement system.

Now I do not believe that this is a conscious destruction, nonetheless, I do believe that the RUC has done more to negatively impact outpatient continuity, chronic care than any single entity.

For another excellent commentary on this issue – The pathophysiology of primary care dwindels.

This issue deserves more attention. We must expose this problem and make it reach the national conscious. I fear that it is important but a bit obtuse. I cannot imagine a sound bite approach to the evil the RUC has wrought.