Another reason Republicans hate Obamacare

[ProSense]

21. Not only

"I responded that that may be a problem with the medical community. I resent your insinuation that my response was akin to a right wing talking point. I am a retired nurse, my husband is a Democrat and a physician. It is not a right wing talking point. It is big discussion on the private doc boards. No one goes to school for that many years just to have some docs in admin somewhere decide how you should best treat your patients. No one likes it when the insurance companies try to do it and no one likes it when some other docs removed from the situation who have never seen your patient do it either. If you have something to say about my response to information YOU posted then please do. I would love to hear it."

...is this an already existing practice, but also the RW fear mongering around it creates the impression that it will ration care (death panels).

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In 1991, as a commissioner on the Physician Payment Review Commission of Congress, I thought the RUC was a useful institution. I continue to believe so.

There is, in my view, great merit in government’s solicitation of the views of the profession whose economic affairs are being partially determined by the Medicare fee schedule. We should be thankful for the dedicated physicians who devote so much of their time to serving on the RUC Indeed, the C.M.S. recently wrote to the RUC, acknowledging its debt to these physicians.

As it happens, however, the C.M.S. tends to accept the RUC’s recommendations on RVU changes more than 90 percent of the time, which effectively makes the RUC the final arbiter in these matters. I do not believe that slavish acceptance of the RUC’s recommendations is a good thing, if only because the physicians on the RUC do labor under at least the appearance of a conflict of interest.

Medicare requires changes in the RVUs to be budget neutral overall, effectively forcing a zero-sum game on the RUC. This means that when the RUC recommends raising the RVU for some services, the RVUs of other services must be decreased. That adjustment has led to the “budget neutrality adjustment” in the American Academy of Family Physicians’ numerical example shown above.

http://economix.blogs.nytimes.com/2010/12/10/the-little-known-decision-makers-for-medicare-physicans-fees/

What is the RUC?

The AMA formed the RUC in 1991 to act as an expert panel in making recommendations to CMS on the relative values of Current Procedural Terminology (CPT) codes using the Resource-Based Relative Value Scale (RBRVS) that was mandated by Congress in 1989. For example, the RUC might propose that a 99214 is worth 2.53 relative value units (RVUs) while a left heart catheterization (code 93510) is worth 40.54 RVUs. RVUs are based on three components – physician work, practice expenses and professional liability; however, the RUC is primarily concerned with the first two (see “Anatomy of a Medicare payment,” and “It's all relative”). The RUC meets three times each year (February, April and September) for the purpose of developing its recommendations, which are then accepted, rejected or modified by CMS.

The RUC is composed of 29 members and 29 alternate members. Twenty-three of the members are appointed by major national medical specialty societies, including the AAFP, and each has one alternate member as well. Three of these seats rotate every two years; two are reserved for an internal medicine subspecialty, and the other is open to any other specialty. Representatives of the CPT Editorial Panel, the Health Care Professionals Advisory Committee and the Practice Expense Review Committee comprise three other seats. The remaining three seats are filled by representatives of the AMA, the American Osteopathic Association and the chair, who is appointed by the AMA. (See “Current RUC composition.”) The AAFP's RUC representative and alternate are appointed by the chair of the AAFP Board of Directors based on recommendations from the AAFP Commission on Practice Enhancement.

Of the 29 members of the RUC, only five currently represent primary care specialties as defined by the AAFP. The vast majority of the representatives to the RUC are appointed by other surgical, procedural or subspecialties. As a result, the work of representing primary care issues to the RUC has often been difficult.

The RUC also has an advisory committee. Each of the 109 specialty societies seated in the AMA House of Delegates, including the AAFP, may appoint one physician to serve on the RUC Advisory Committee. The advisers attend the RUC meetings and present their societies' recommendations, which the RUC evaluates. Specialties represented on both the RUC and the Advisory Committee must appoint different physicians to each committee to distinguish the role of advocate (i.e., the adviser) from that of evaluator (i.e., the RUC member). The AAFP's RUC adviser, like the RUC representative and alternate, is appointed by the chair of the AAFP Board of Directors.

http://www.aafp.org/fpm/2008/0200/p36.html

The IAPB brings this practice into the light. The members have to be confirmed by the Senate and the board's recommendations have to be approved by Congress.

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Key to these savings is a proposal to strengthen the Independent Payment Advisory Board – IPAB, which was created by the Affordable Care Act. Here’s how IPAB works:

• 15 experts including doctors and patient advocates would be nominated by the President and confirmed by the Senate to serve on IPAB.
  
  
• IPAB would recommend policies to Congress to help Medicare provide better care at lower costs. This could include ideas on coordinating care, getting rid of waste in the system, incentivizing best practices, and prioritizing primary care.
  
  
• IPAB is specifically prohibited by law from recommending any policies that ration care, raise taxes, increase premiums or cost-sharing, restrict benefits or modify who is eligible for Medicare.
  
  
• Congress then has the power to accept or reject these recommendations. If Congress rejects the recommendations, and Medicare spending exceeds specific targets, Congress must either enact policies that achieve equivalent savings or let the Secretary of Health and Human Services follow IPAB’s recommendations.

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http://www.whitehouse.gov/blog/2011/04/20/facts-about-independent-payment-advisory-board