Ruc Flawed But Functional

5 Nov

Essentially they’re responding to the government’s desire to let a third party inflict pain, without a logical model.” Dr. Sanchez adds, “They want to review some of the dermatology codes, but they’re not asking dermatologists to get involved. They’re asking family practitioners, who aren’t the typical practitioner” who uses those codes. Dr. Kaufmann says that as a participant in the RUC process, he would prefer that these determinations remained under the RUC purview. However, he says, the specialty of dermatology will “have to abide by whatever recommendations these projects make to the RUC if CMS tells us we have to.” Additionally, the American Academy of Family Physicians (AAFP) has proposed that CMS create primary-care-specific E/M codes with higher relative values to reflect more demanding E/M requirements in primary care versus specialties. However, Dr. Kaufmann says, dermatology opposes specialty-specific codes. “From the RUC perspective,” he says, “an office visit is an office visit, no matter who’s doing it.” Dr. Siegel adds, “The primary-care-as-gatekeeper model was tried in the 1990s and for an assortment of reasons fell out of favor.” Addressing the concern that RVUs always ascend over time, Dr. Siegel counters, “That’s not true.” Specialties in which payments have declined in recent years include pathology and cardiology, he says. Furthermore, he says CMS does not simply rubber-stamp RUC recommendations. In fact, Dr. Kaufmann says that the percentage of RUC recommendations adopted by CMS has fallen from greater than 90 percent to 87 percent for 2012.1 Taken together or separately, Dr. Siegel says, the many proposed RUC remedies are all worrisome.


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