Physicians Sue to Replace the RUC

A group of six primary care physicians in Augusta, Ga., has filed a lawsuit seeking to bar Medicare officials from using advice from the American Medical Association’s Specialty Society Relative Value Scale Update Committee (RUC) when setting payment rates for physicians.

The complaint, which was filed Aug. 8 in the U.S. District Court for the District of Maryland, contends that the Department of Health and Human Services and the Centers for Medicare and Medicaid Services are violating the Federal Advisory Committee Act, the Administrative Procedure Act, the Affordable Care Act, and the U.S. Constitution in their reliance on the RUC. And the physicians claim that both primary care physicians and patients are being harmed because the RUC overvalues procedures and undervalues primary care.

The RUC, which is operated by the AMA, makes annual recommendations to CMS on how to value a number of physician services under Medicare. The 29-member panel includes representatives from various medical specialties and primary care. CMS officials are under no obligation to accept the RUC’s suggestions, but for nearly 20 years, they have followed more than 90% of the panel’s recommendations.

The six plaintiffs, who are all physicians in the same primary care practice, allege that during the time that the CMS has used the RUC’s advice in determining physician payment under the Medicare Physician Fee Schedule, the process has become "irrational, arbitrary, and absolutely destined to lead to the continued devastation of primary care," according to the complaint.

The physicians involved in the lawsuit charge that the RUC is biased toward procedural specialties, particularly surgical specialties. That bias, they wrote, has led to a massive pay discrepancy between procedural specialties and primary care, which has contributed to a shortage of primary care physicians, limited access to primary care services, and increasingly shortened patient visits.

Dr. Paul M. Fischer, a family physician in Augusta, Ga., is one of the plaintiffs in the lawsuit and has been working for several months to replace the RUC. He said in an interview that he’s hopeful that they will win their legal battle and succeed in forcing CMS to move toward a new process for setting physician payments that is "more transparent, open, and fair."

Officials at CMS had no comment on the lawsuit since it is the agency’s policy not to comment on pending legal issues. However, the AMA defended the RUC and its processes.

"The RUC is an independent panel of physicians from all medical specialties, including primary care, who make recommendations to CMS as all citizens have a right to do," said Dr. Barbara Levy, the chairwoman of the RUC. "These volunteers provide physicians’ voice and expertise to Medicare decision makers through their recommendations."

A group of six primary care physicians in Augusta, Ga., has filed a lawsuit seeking to bar Medicare officials from using advice from the American Medical Association’s Specialty Society Relative Value Scale Update Committee (RUC) when setting payment rates for physicians.

The complaint, which was filed Aug. 8 in the U.S. District Court for the District of Maryland, contends that the Department of Health and Human Services and the Centers for Medicare and Medicaid Services are violating the Federal Advisory Committee Act, the Administrative Procedure Act, the Affordable Care Act, and the U.S. Constitution in their reliance on the RUC. And the physicians claim that both primary care physicians and patients are being harmed because the RUC overvalues procedures and undervalues primary care.

The RUC, which is operated by the AMA, makes annual recommendations to CMS on how to value a number of physician services under Medicare. The 29-member panel includes representatives from various medical specialties and primary care. CMS officials are under no obligation to accept the RUC’s suggestions, but for nearly 20 years, they have followed more than 90% of the panel’s recommendations.

The six plaintiffs, who are all physicians in the same primary care practice, allege that during the time that the CMS has used the RUC’s advice in determining physician payment under the Medicare Physician Fee Schedule, the process has become "irrational, arbitrary, and absolutely destined to lead to the continued devastation of primary care," according to the complaint.

The physicians involved in the lawsuit charge that the RUC is biased toward procedural specialties, particularly surgical specialties. That bias, they wrote, has led to a massive pay discrepancy between procedural specialties and primary care, which has contributed to a shortage of primary care physicians, limited access to primary care services, and increasingly shortened patient visits.

Dr. Paul M. Fischer, a family physician in Augusta, Ga., is one of the plaintiffs in the lawsuit and has been working for several months to replace the RUC. He said in an interview that he’s hopeful that they will win their legal battle and succeed in forcing CMS to move toward a new process for setting physician payments that is "more transparent, open, and fair."

Officials at CMS had no comment on the lawsuit since it is the agency’s policy not to comment on pending legal issues. However, the AMA defended the RUC and its processes.

"The RUC is an independent panel of physicians from all medical specialties, including primary care, who make recommendations to CMS as all citizens have a right to do," said Dr. Barbara Levy, the chairwoman of the RUC. "These volunteers provide physicians’ voice and expertise to Medicare decision makers through their recommendations."

A group of six primary care physicians in Augusta, Ga., has filed a lawsuit seeking to bar Medicare officials from using advice from the American Medical Association’s Specialty Society Relative Value Scale Update Committee (RUC) when setting payment rates for physicians.

The complaint, which was filed Aug. 8 in the U.S. District Court for the District of Maryland, contends that the Department of Health and Human Services and the Centers for Medicare and Medicaid Services are violating the Federal Advisory Committee Act, the Administrative Procedure Act, the Affordable Care Act, and the U.S. Constitution in their reliance on the RUC. And the physicians claim that both primary care physicians and patients are being harmed because the RUC overvalues procedures and undervalues primary care.

The RUC, which is operated by the AMA, makes annual recommendations to CMS on how to value a number of physician services under Medicare. The 29-member panel includes representatives from various medical specialties and primary care. CMS officials are under no obligation to accept the RUC’s suggestions, but for nearly 20 years, they have followed more than 90% of the panel’s recommendations.

The six plaintiffs, who are all physicians in the same primary care practice, allege that during the time that the CMS has used the RUC’s advice in determining physician payment under the Medicare Physician Fee Schedule, the process has become "irrational, arbitrary, and absolutely destined to lead to the continued devastation of primary care," according to the complaint.

The physicians involved in the lawsuit charge that the RUC is biased toward procedural specialties, particularly surgical specialties. That bias, they wrote, has led to a massive pay discrepancy between procedural specialties and primary care, which has contributed to a shortage of primary care physicians, limited access to primary care services, and increasingly shortened patient visits.

Dr. Paul M. Fischer, a family physician in Augusta, Ga., is one of the plaintiffs in the lawsuit and has been working for several months to replace the RUC. He said in an interview that he’s hopeful that they will win their legal battle and succeed in forcing CMS to move toward a new process for setting physician payments that is "more transparent, open, and fair."

Officials at CMS had no comment on the lawsuit since it is the agency’s policy not to comment on pending legal issues. However, the AMA defended the RUC and its processes.

"The RUC is an independent panel of physicians from all medical specialties, including primary care, who make recommendations to CMS as all citizens have a right to do," said Dr. Barbara Levy, the chairwoman of the RUC. "These volunteers provide physicians’ voice and expertise to Medicare decision makers through their recommendations."