CMS Evaluates RUC Process

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  • October 21, 2009
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If, in fact, Medicare rates for physician services are inaccurate, how might the system be improved? The Medicare Payment Advisory Commission (MedPAC) met earlier this month to answer that very question. In November, the Centers for Medicare & Medicaid Services (CMS) will look at how relative values units (RVUs) are determined during a key process known as the five-year review, which will include a public comment period.

The AMA/Specialty Society Relative Value Scale Update Committee (RUC) recommends to CMS how to adjust RVUs for Medicare services. CMS reviews the recommendations from RUC, which is made up of physicians from a number of specialties, and adopts most of them. Their recommendations help build the Medicare Physician Fee Schedule (MPFS), drive Medicare payments, and affect how codes are unbundled.

MedPAC recommended in 2006 the Department of Health and Human Services (HHS) secretary establish a separate panel with expertise in clinical care and health economics to give additional advice on services that may be overvalued or undervalued. HHS commissioned a report in 2008 to determine why utilization of 10 selected physician service categories in Medicare increased significantly between 2000 and 2006. Researchers concluded volume growth for most of the categories could be tied largely to more physicians offering treatments and more patients asking for them. But higher Medicare rates for some services in those categories due to RVU adjustments played a role.

RVUs/payment were a major factor in driving volume

  • Procedures for benign prostatic hyperplasia
  • Electrodiagnostic testing for nerve problems

RVUs/payment were a contributing factor in driving volume

  • Spinal injection procedures for back pain
  • Polysomnography for sleep apnea
  • Diagnosis and medication therapy for macular degeneration
  • Mohs surgery for skin cancer
  • Cardiac stress testing for coronary artery disease

RVUs/payment were no factor in driving volume

  • Computed tomography/magnetic resonance imaging of the brain
  • Computed tomography/magnetic resonance imaging of the lumbar spine
  • Cardiac defibrillator implantation to prevent sudden death

Source: “Volume Growth in Medicare: An Investigation of Ten Physicians’ Services,” RAND Health/Urban Institute, December 2008.

For more information, read the article “Medicare pricing gets new look; RUC process revisited” (Silva, Oct. 19).

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