Panel marks 10 years of shaping Medicare policy

More than 90% of the Relative Value Scale Update Committee's recommendations are adopted, yet pay rates are strictly controlled by Congress.

By Markian Hawryluk, AMNews staff. Dec. 16, 2002.

Washington -- It's not easy getting two out of three doctors to agree. So it's no wonder the federal government listens to them when they do.

For the last 10 years, a physician panel has tackled the thorny issue of weighing the relative value of physician work and practice expenses involved in the thousands of procedures performed by physicians each year. The Relative Value Scale Update Committee, or RUC, has managed to settle differences between specialties in-house and make united recommendations to Medicare that are accepted more than 90% of the time.

"The RUC is probably the best example we have going today of a private-public relationship," said James G. Hoehn, MD, a plastic surgeon from Albany, N.Y., who chairs the panel. "It's an excellent example of how when people are interested in getting the job done, they can work together to get the job done."

RUC was created in 1991 as Medicare moved to a resource-based physician payment system. Payments to doctors are based on three components: physician work, practice expense and liability insurance costs. The Centers for Medicare & Medicaid Services developed a listing of the services provided by physicians ranked by the amount of physician work involved, the technical skill and physical effort required, the mental effort and judgment needed, and the stress resulting from the potential risk to the patient.

Once the initial ranking of the list was in place, physicians wanted a methodology to maintain and update that list to reflect changes in the work involved and the impact of new technology. The American Medical Association tapped Grant V. Rodkey, MD, a Boston surgeon, to head a committee of specialty society representatives. His first challenge was to get the myriad specialties represented to work together and trust each other. [...]