AAFP Calls For Revisions to RVU Formula

Cheryl Clark, for HealthLeaders Media , July 25, 2011

That's needed, McDermott says, because primary care physicians make up only one-sixth to one sixteenth of the RUC's membership, even though "primary care physicians provide about half of Medicare physician visits."

"CMS has depended on the AMA's RUC for recommendations as to the values assigned to Medicare service codes for over 90% of all code changes over the last 19 years," states language in the bill.

"The RUC lacks voting transparency and relies on self-reported and unrepresentative survey data that present serious conflict-of-interest concerns," the bill adds.

The RUC does identify and correct undervalued codes, but "it does not have the same incentives to find and correct overvalued codes. Specialists, especially those who derive the majority of their income through procedural codes, have no incentive to reduce the value of potential overvalued codes," McDermott's bill says.

Heim and Gary Rosenthal, MD, president of the Society of General Internal Medicine, said in a letter to House Speaker John Boehner they support McDermott's bill because analytical contractors – that second opinion – "will lend an element of depth, data, deliberation and inclusiveness not currently available to CMS or at the RUC."

The bottom line, Heim says is that "if we don't pay for the doctor who gives the good physical exam – methodologically, which is what we think needs to be better valued – if we don't do a better job of this, we're not going to have medical students going into primary care."

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2 comments on "AAFP Calls For Revisions to RVU Formula"

Marilyn Masick (7/25/2011 at 10:50 AM)
The RVU's were developed, and include the work expense component. This, combined with the Medicare points system and the CPT levels of E and M, codes result in the cognitive function being included. This is already a part of the current E and M documentation system. Adequate and appropriate training on E and M would be good for someone who doesn't understand how that works.

Jacob Kuriyan (7/25/2011 at 9:41 AM)
Improving reimbursements to all doctors who provide time consuming "cognitive" services in a "[INVALID]ive manner" is desirable. I go beyond family practitioners and include neurologists, for example, in this preferred group. Simply paying more for a particular procedure code ( as we do currently) will not work as it will also reward specialists who use such codes, whether they provide time consuming cognitive services or not. There is a serious omission in the article. The origin of this disparity can be laid at the feet of primary care physicians and their professional groups. When the California Medical Association invited physicians to participate in designing RVS codes (precursor to CPT codes in use today) only specialists showed any interest in working on it. With few if any PCPs involved it is no surprise that "procedure" based practices were amply rewarded. Once adopted by insurers, California suregeons saw their incomce sky-rocket compared to their PCP colleagues. There is a lesson to be learned here. Organizations like AAFP must play an active and positive role in health reform related activities (ACOs, PCMHs etc.) and not sit on the side-lines complaining about "Obamacare". They should focus on PCP issues and figure out a way to help them thrive under health reform initiataives.




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