Docs sue CMS, launch task force to improve primary care pay

In a symbolic move representing physicians' frustration over having their Medicare reimbursement determined by a secret panel known as the Relative Value Scale Update Committee (RUC), six Georgia physicians filed a lawsuit earlier this month against the Centers for Medicare & Medicaid Services (CMS) for what they allege is an illegal reliance on the 29-member panel convened by the American Medical Association.

According to the plaintiffs, the arrangement between CMS and the RUC violates statutes governing federal advisory committees and is responsible for physician shortages in primary care. "I believe that the RUC for 20 years has disadvantaged primary care, overpaid many specialists, and contributed to the crisis in primary care today," said one of the plaintiffs, Dr. Paul Fischer from the Center for Primary Care in Evans, Ga., in an American Medical News article.

Although CMS considers the recommendations by RUC, it is not obligated to accept them. Medicare law also requires the RUC review RVUs at least every five years to identify services that might be over- or underpaid by Medicare.

According to a June 6 notice in the Federal Register, CMS has proposed accepting only 51% of the RUC's recommendations for relative value changes to physician services set to go into effect Jan. 1, 2012. However, amnews notes that CMS has agreed with more than 90% of RUC recommendations in previous years.

Although CMS declined to comment on the pending case, RUC's chair Dr. Barbara Levy released the following statement: "The RUC is an independent panel of physicians from all medical specialties, including primary care, who make recommendations to CMS as all citizens have a right to do. These volunteers provide physicians' voice and expertise to Medicare decision-makers through their recommendations."

Although asked to be a party to the complaint against CMS, the American Academy of Family Physicians (AAFP) instead opted to pursue alternative options to address payment fairness for primary care physicians. In a June letter, the AAFP called for more seats for primary care on the RUC board, including a permanent seat for geriatric medicine, and greater voting transparency on all RUC votes. The AAFP also has created a Primary Care Valuation Task Force to make recommendations to CMS about more accurately paying for primary care services.

The task force's first meeting, which took place Aug. 22 in Washington, began work on determining how Medicare should better compensate "high-functioning primary care practices." However, because it will take time for practices to obtain these standards, which include some aspects of the medical home, task force chair and AAFP board chair Lori Heim, also declared an immediate need for "an across-the-board improved payment for primary care," AAFP News Now reports.

To learn more:
- read the article from American Medical News
- see the article from Healthcare Finance News
- read about the AAFP's stance
- check out the AAFP's letter (.pdf) to the RUC
- read about the AAFP's task force