This follow-on from my previous blog is for those who want the nitty gritty.

The committee (called the RUC for Relative Value Update Committee) I referred to has been active since the early 1990s. It meets several times a year, is run by the AMA and is constituted by physicians from most medical specialties with the participation of Medicare representatives. After a considerable amount of discussion and debate the RUC develops and recommends to Medicare values for new procedures and revaluations of established procedures. With such broad representation the recommended values are typically appropriate and  fair in the way they divide up the Medicare “pie.” Historically, Medicare accepted nearly 100% of RUC recommended values but more recently have been swayed by political considerations and arbitrarily assigning new values. The future of the RUC is, I think, uncertain.

There are several misconceptions about the RUC that appear in the media. One is that this is a secret committee that does its work in a clandestine fashion. Not the case. Over several days of meetings, hundreds of physicians with their staff and several Medicare representatives participate. The final outcomes are published in the Federal Register. (reading which I recommend if you have trouble falling asleep) Another misconception is that we doctors are using this committee to get more money for ourselves from Medicare. Not possible. The total amount of money in the Medicare pot is fixed. All the committee is doing is allocating the appropriate amount for each procedure. Physicians on the committee help distribute the dollars but can’t affect the total amount.