Family docs not ready to leave AMA group with influence over Medicare pay

Introduction

The American Academy of Family Physicians this week declined to drop out of a little-known committee that wields powerful influence over Medicare payment to doctors, despite pressure from some of its members to leave the group.

Late last month, Dr. Roland Goertz, the president of the academy, said its board planned to discuss giving up membership in the American Medical Association/Specialty Society Relative Value Update Committee, or RUC, a committee the family physicians’ group has long criticized for under-valuing the work of family doctors. Goertz said then the RUC issue could be decided in a board vote.

In an interview Friday, however, Goertz said the board met this week and was unable to reach a decision about its participation in the RUC. He said the issue is still on the table, but was unsure of the timetable for resolving it.

“AAFP’s continued participation in the RUC is a serious decision that cannot be made lightly,” Goertz said. “We want to make sure we have investigated every conceivable impact on family medicine and primary care physicians and the patients we serve.”

The RUC is a group of 29 physicians nominated by medical specialty societies that advises the Centers for Medicare & Medicaid Services (CMS) on the relative values of medical procedures. Technically, the group simply recommends procedure values, but CMS accepts the RUC’s recommendations more than 90 percent of the time, which has led to criticism that the arrangement is a conflict of interest allowing physicians a key role in determining what Medicare pays them. The workings of the RUC and the controversy over its practices were detailed in a Center for Public Integrity piece last November.

Pay is at root of the conflict between family physicians and the RUC.

According to a 2010 study in the journal Health Affairs, a cardiologist’s yearly paycheck is more than $100,000 fatter than the paycheck of a primary care doctor. The pay gap, health policy analysts say, has led profit-minded medical students to flock to more lucrative sub-specialties including cardiology and radiology, which in turn has led to a shortage of family doctors. Profit incentives for physicians to perform medical procedures and tests commanding higher payments has also helped bleed the Medicare trust fund, according to analysts

Although the family doctors’ group participates in the RUC, its leadership has long said the committee helped create and maintain the physician pay gap by overvaluing invasive procedures and undervaluing face-to-face patient evaluation and disease management. Primary care physicians, who provide 44 percent of Medicare-paid office visits, are a distinct minority on the RUC.

The American Medical Association, which funds the RUC, said the committee does not discriminate against family physicians. In response to the American Academy of Family Physicians’ decision not to leave the RUC at this time, AMA president Dr. Cecil B. Wilson, in a prepared statement, said, “The RUC is able to provide valuable recommendations to Medicare on the work and resources involved in patient care because it is an expert panel of volunteer physicians from all medical specialties, including primary care. Family physicians provide invaluable expertise and service to the RUC.”

The New Jersey Academy of Family Physicians, along with some vocal members of the family physicians’ group, had urged the nationwide group to give up its RUC membership. If the largest organization representing family physicians dropped out, they said, the RUC would lose its legitimacy, forcing the Centers for Medicare & Medicaid Services to rely on other methods to set values for procedures.

Ray Saputelli, executive vice president of the New Jersey academy, on Friday said he is still confident that the American Academy of Family Physicans will eventually decide to leave the RUC. “There is consistency of opinion that the RUC is broken,” Saputelli said. “There may be a difference of opinion about how to fix it, but I think they will come to the right decision.”

Brian Klepper, a health care consultant and commentator who has spearheaded the movement against the RUC, said he hasn’t given up. “We’ll continue to campaign against this cancer on the American health care system,” said Klepper, who is recruiting support on his website Replace the RUC!

It is clear, though, that Klepper and others are disappointed that the family doctors’ organization so far has not joined their cause. An effort in Congress to limit the RUC’s influence has also gathered little steam. In late March, Rep. Jim McDermott, D-Wash., introduced a bill that would require CMS to use independent contractors to identify incorrectly valued physician services in Medicare. Since March, however, only two Congressmen have signed on to McDermott’s bill, which is opposed by the AMA.