Talk or Walk? AAFP Wrangles Over RUC

ORLANDO – Part update, part rallying cry, the policy leaders of the American Academy of Family Physicians updated delegates this week on how the academy is getting more aggressive and more specific in its demands to increase the role of, and reimbursement for, primary care physicians through the American Medical Association committee that advises on Medicare payments.

There has been no official word yet from the Relative Value Scale Update Committee (RUC) in response to a public letter sent by the AAFP to RUC chair Dr. Barbara Levy in June, said Dr. Lori Heim, outgoing chair of the AAFP board of directors.

Although the AAFP has sent letters in the past, this time they set a specific deadline for a response – Mar. 1, 2012 – and outlined some very specific requests.

The AAFP wants the RUC to add four additional primary care seats (one each for the AAFP, the American Academy of Pediatrics, the American College of Physicians, and the American Osteopathic Association); add a seat for geriatrics; add three new seats for "external representatives" that could include patients, employers, health systems, and health plans; and institute voting transparency.

"Payment is front and center for a lot of what we are doing and for a lot of the problems we’re seeing throughout the country in terms of primary care," Dr. Heim said at the annual AAFP Congress of Delegates.

"We know primary care is particularly disadvantaged because of how the RUC is composed. If Medicare is undervaluing us, then that bottom is even lower than what we can sustain," she added.

Although the AAFP also is advocating for increased payment from private insurers, it all goes back to Medicare, said Dr. Heim, who is also a family physician in Vass, N.C.

"Our objective is to increase payment for primary care physicians," she explained. "We know if we cannot afford to keep our doors open, it affects our community."

While awaiting a response from the RUC, the AAFP also is devising its own recommendations on primary care payment to send to the Centers for Medicare and Medicaid Services. To accomplish that, the academy formed the AAFP Primary Care Valuation Task Force. The group includes 22 members from a variety of disciplines, including policy makers, payment experts, patients, employers, and AAFP board members. "Having that variety of voices is incredibly helpful," Dr. Heim said.

AAFP members will be able to follow task force progress. "We are going to be transparent, because that is what we want the RUC to do," Dr. Heim said.

Should They Stay or Go?

Some AAFP delegates, however, weren’t willing to wait for a response from the RUC. Four resolutions to immediately withdraw from the RUC and/or form an alternative, independent relative value scale advisory board to CMS were introduced at the congress.

After RUC wrangling, or "extensive, impassioned testimony on all sides," the AAFP Reference Committee on Practice Enhancement decided it was premature for the academy to leave the RUC. They also stated that the majority of AFFP members support the current strategy to lobby for greater representation. The reference committee recommended referring the four resolutions to the board of directors, and a vote by delegates approved this move.

So, the wait continues for a response from RUC. No matter what happens, "the board will tackle it and make a very deliberate decision whenever we find out what RUC tell us," said Dr. Roland Goertz, who replaces Dr. Heim this month as chair of the board.

Dr. Goertz added that the RUC committee asked him to attend their meeting Sept. 23, 2011, at which he’ll be allotted 5 minutes to explain the AAFP position in person.

Dr. Paul Fischer and colleagues in Georgia took a more aggressive approach when they filed a lawsuit against CMS earlier this year. "The basis of this suit has to do with the RUC," Dr. Fischer said at the congress. Because of a lack of transparency, "the relationship between the RUC and Medicare is clearly illegal."

The RUC also came up in a couple of questions during a candidate forum with the two men vying to become AAFP president-elect. They each replied no when asked if the academy should join in the lawsuit against the RUC. Dr. Jeffrey J. Cain, a family physician from Denver, said the AAFP should not sue the RUC at the same time they are negotiating with them. "Did any of you grow up in a small town? One lesson you learn is you don’t sue the guy fixing your car until you get your keys back."

The other candidate, Dr. George W. Shannon, pointed out that lawsuits can take a long time to resolve and could go past the March 2012 deadline for the RUC response. He prefers the current strategy to approach the RUC and request greater representation.

Each candidate also was asked: If March 2012 arrives and there is still no significant change in the RUC, what will be your recommendation?

"The head of CMS wants a viable alternative on the table. That’s why we have a new task force," Dr. Cain said. "We are using the time right now to develop an alternative method."

"It was a professional, collegial move sending a letter and outlining what our difficulties are, giving RUC two meeting cycles to respond, and saying no matter what they respond, we are going to evaluate," Dr. Shannon said.

Dr. Heim, Dr. Goertz, Dr. Cain, and Dr. Shannon said that they had no relevant financial disclosures.

ORLANDO – Part update, part rallying cry, the policy leaders of the American Academy of Family Physicians updated delegates this week on how the academy is getting more aggressive and more specific in its demands to increase the role of, and reimbursement for, primary care physicians through the American Medical Association committee that advises on Medicare payments.

There has been no official word yet from the Relative Value Scale Update Committee (RUC) in response to a public letter sent by the AAFP to RUC chair Dr. Barbara Levy in June, said Dr. Lori Heim, outgoing chair of the AAFP board of directors.

Although the AAFP has sent letters in the past, this time they set a specific deadline for a response – Mar. 1, 2012 – and outlined some very specific requests.

The AAFP wants the RUC to add four additional primary care seats (one each for the AAFP, the American Academy of Pediatrics, the American College of Physicians, and the American Osteopathic Association); add a seat for geriatrics; add three new seats for "external representatives" that could include patients, employers, health systems, and health plans; and institute voting transparency.

"Payment is front and center for a lot of what we are doing and for a lot of the problems we’re seeing throughout the country in terms of primary care," Dr. Heim said at the annual AAFP Congress of Delegates.

"We know primary care is particularly disadvantaged because of how the RUC is composed. If Medicare is undervaluing us, then that bottom is even lower than what we can sustain," she added.

Although the AAFP also is advocating for increased payment from private insurers, it all goes back to Medicare, said Dr. Heim, who is also a family physician in Vass, N.C.

"Our objective is to increase payment for primary care physicians," she explained. "We know if we cannot afford to keep our doors open, it affects our community."

While awaiting a response from the RUC, the AAFP also is devising its own recommendations on primary care payment to send to the Centers for Medicare and Medicaid Services. To accomplish that, the academy formed the AAFP Primary Care Valuation Task Force. The group includes 22 members from a variety of disciplines, including policy makers, payment experts, patients, employers, and AAFP board members. "Having that variety of voices is incredibly helpful," Dr. Heim said.

AAFP members will be able to follow task force progress. "We are going to be transparent, because that is what we want the RUC to do," Dr. Heim said.

Should They Stay or Go?

Some AAFP delegates, however, weren’t willing to wait for a response from the RUC. Four resolutions to immediately withdraw from the RUC and/or form an alternative, independent relative value scale advisory board to CMS were introduced at the congress.

After RUC wrangling, or "extensive, impassioned testimony on all sides," the AAFP Reference Committee on Practice Enhancement decided it was premature for the academy to leave the RUC. They also stated that the majority of AFFP members support the current strategy to lobby for greater representation. The reference committee recommended referring the four resolutions to the board of directors, and a vote by delegates approved this move.

So, the wait continues for a response from RUC. No matter what happens, "the board will tackle it and make a very deliberate decision whenever we find out what RUC tell us," said Dr. Roland Goertz, who replaces Dr. Heim this month as chair of the board.

Dr. Goertz added that the RUC committee asked him to attend their meeting Sept. 23, 2011, at which he’ll be allotted 5 minutes to explain the AAFP position in person.

Dr. Paul Fischer and colleagues in Georgia took a more aggressive approach when they filed a lawsuit against CMS earlier this year. "The basis of this suit has to do with the RUC," Dr. Fischer said at the congress. Because of a lack of transparency, "the relationship between the RUC and Medicare is clearly illegal."

The RUC also came up in a couple of questions during a candidate forum with the two men vying to become AAFP president-elect. They each replied no when asked if the academy should join in the lawsuit against the RUC. Dr. Jeffrey J. Cain, a family physician from Denver, said the AAFP should not sue the RUC at the same time they are negotiating with them. "Did any of you grow up in a small town? One lesson you learn is you don’t sue the guy fixing your car until you get your keys back."

The other candidate, Dr. George W. Shannon, pointed out that lawsuits can take a long time to resolve and could go past the March 2012 deadline for the RUC response. He prefers the current strategy to approach the RUC and request greater representation.

Each candidate also was asked: If March 2012 arrives and there is still no significant change in the RUC, what will be your recommendation?

"The head of CMS wants a viable alternative on the table. That’s why we have a new task force," Dr. Cain said. "We are using the time right now to develop an alternative method."

"It was a professional, collegial move sending a letter and outlining what our difficulties are, giving RUC two meeting cycles to respond, and saying no matter what they respond, we are going to evaluate," Dr. Shannon said.

Dr. Heim, Dr. Goertz, Dr. Cain, and Dr. Shannon said that they had no relevant financial disclosures.

ORLANDO – Part update, part rallying cry, the policy leaders of the American Academy of Family Physicians updated delegates this week on how the academy is getting more aggressive and more specific in its demands to increase the role of, and reimbursement for, primary care physicians through the American Medical Association committee that advises on Medicare payments.

There has been no official word yet from the Relative Value Scale Update Committee (RUC) in response to a public letter sent by the AAFP to RUC chair Dr. Barbara Levy in June, said Dr. Lori Heim, outgoing chair of the AAFP board of directors.

Although the AAFP has sent letters in the past, this time they set a specific deadline for a response – Mar. 1, 2012 – and outlined some very specific requests.

The AAFP wants the RUC to add four additional primary care seats (one each for the AAFP, the American Academy of Pediatrics, the American College of Physicians, and the American Osteopathic Association); add a seat for geriatrics; add three new seats for "external representatives" that could include patients, employers, health systems, and health plans; and institute voting transparency.

"Payment is front and center for a lot of what we are doing and for a lot of the problems we’re seeing throughout the country in terms of primary care," Dr. Heim said at the annual AAFP Congress of Delegates.

"We know primary care is particularly disadvantaged because of how the RUC is composed. If Medicare is undervaluing us, then that bottom is even lower than what we can sustain," she added.

Although the AAFP also is advocating for increased payment from private insurers, it all goes back to Medicare, said Dr. Heim, who is also a family physician in Vass, N.C.

"Our objective is to increase payment for primary care physicians," she explained. "We know if we cannot afford to keep our doors open, it affects our community."

While awaiting a response from the RUC, the AAFP also is devising its own recommendations on primary care payment to send to the Centers for Medicare and Medicaid Services. To accomplish that, the academy formed the AAFP Primary Care Valuation Task Force. The group includes 22 members from a variety of disciplines, including policy makers, payment experts, patients, employers, and AAFP board members. "Having that variety of voices is incredibly helpful," Dr. Heim said.

AAFP members will be able to follow task force progress. "We are going to be transparent, because that is what we want the RUC to do," Dr. Heim said.

Should They Stay or Go?

Some AAFP delegates, however, weren’t willing to wait for a response from the RUC. Four resolutions to immediately withdraw from the RUC and/or form an alternative, independent relative value scale advisory board to CMS were introduced at the congress.

After RUC wrangling, or "extensive, impassioned testimony on all sides," the AAFP Reference Committee on Practice Enhancement decided it was premature for the academy to leave the RUC. They also stated that the majority of AFFP members support the current strategy to lobby for greater representation. The reference committee recommended referring the four resolutions to the board of directors, and a vote by delegates approved this move.

So, the wait continues for a response from RUC. No matter what happens, "the board will tackle it and make a very deliberate decision whenever we find out what RUC tell us," said Dr. Roland Goertz, who replaces Dr. Heim this month as chair of the board.

Dr. Goertz added that the RUC committee asked him to attend their meeting Sept. 23, 2011, at which he’ll be allotted 5 minutes to explain the AAFP position in person.

Dr. Paul Fischer and colleagues in Georgia took a more aggressive approach when they filed a lawsuit against CMS earlier this year. "The basis of this suit has to do with the RUC," Dr. Fischer said at the congress. Because of a lack of transparency, "the relationship between the RUC and Medicare is clearly illegal."

The RUC also came up in a couple of questions during a candidate forum with the two men vying to become AAFP president-elect. They each replied no when asked if the academy should join in the lawsuit against the RUC. Dr. Jeffrey J. Cain, a family physician from Denver, said the AAFP should not sue the RUC at the same time they are negotiating with them. "Did any of you grow up in a small town? One lesson you learn is you don’t sue the guy fixing your car until you get your keys back."

The other candidate, Dr. George W. Shannon, pointed out that lawsuits can take a long time to resolve and could go past the March 2012 deadline for the RUC response. He prefers the current strategy to approach the RUC and request greater representation.

Each candidate also was asked: If March 2012 arrives and there is still no significant change in the RUC, what will be your recommendation?

"The head of CMS wants a viable alternative on the table. That’s why we have a new task force," Dr. Cain said. "We are using the time right now to develop an alternative method."

"It was a professional, collegial move sending a letter and outlining what our difficulties are, giving RUC two meeting cycles to respond, and saying no matter what they respond, we are going to evaluate," Dr. Shannon said.

Dr. Heim, Dr. Goertz, Dr. Cain, and Dr. Shannon said that they had no relevant financial disclosures.