American College of Physicians: Internal Medicine — Doctors for Adults ®

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Help ACP determine Medicare's physician service payments

From the July/August ACP Internist, copyright 2010 by the American College of Physicians

By Debra Lansey

ACP will ask randomly chosen members to complete a survey this summer to influence Medicare reimbursement for services common to internal medicine. Survey results will become the primary source of data Medicare uses to determine reimbursement, so it is essential that ACP members complete surveys if they receive an invitation by e-mail.

The Centers for Medicare and Medicaid Services (CMS) bases payment for physician services on the Resource-Based Relative Value Scale (RBRVS), which reimburses for services based on the resources and costs involved in furnishing all medical services, relative to each other.

CMS expresses these costs as relative value units (RVUs). The agency assigns three different RVU components for each service based on:

  • the work a physician must do,
  • administrative overhead expenses involved in providing the service, and
  • professional liability insurance.

To compute the payment to a physician, all three relative value components are further adjusted to account for geographic differences in cost. Their sum equals the total RVU for a service. Finally, CMS sets a conversion factor expressed in dollars to derive the actual payment amount.

Q: How do specialties provide input to the relative values Medicare assigns to services?

Help ACP determine Medicare's physician service payments

A: ACP and other physician organizations engage CMS directly regarding RBRVS maintenance and Medicare payments. There are two major groups of physicians involved in the Relative Value Update Committee (RUC) process: the RUC members and the specialty advisors. The American Medical Association, in collaboration with physician specialty organizations, convenes a committee of physicians that makes RVU recommendations to CMS. Specialties appoint RUC members; these committee members are joined by a broader group of specialty organizations to appoint physicians who represent their respective specialties and serve in an advisory role.

Q: How does the RUC make recommendations to CMS?

A: The RUC generally makes recommendations on services before they first appear in the Current Procedural Terminology code book. It also makes recommendations on services the agency identifies for an accuracy assessment, as part of a statutorily mandated review done every five years.

Q: What information is collected?

A: The RUC uses standard survey instruments that are based on the type of service. The survey uses a seven-part form that asks for answers about the amount of time, mental effort, medical judgment and patient risk involved in a particular service. It also asks the physician to compare the intensity of these activities to other medical services and procedures. Physicians' responses provide necessary insight to the evolving work and resource demands of medical practice.

Q: How is it collected?

A: Specialty organizations conduct the RUC surveys. Each specialty decides which services to survey based on how commonly its members perform them. For example, this year ACP will survey members on the work and direct overhead involved in visits in the observation setting. The process works as follows:

  • ACP sends an e-mail to selected members requesting that they complete a survey on observation care services;
  • ACP coding and payment experts use the survey data and other pertinent factors to decide on the College's observation care service recommendations;
  • College representatives present those recommendations to the RUC to convince their peers that they are appropriate; and
  • The RUC, with that input from its advisory committee, decides on a recommendation that it then transmits to CMS.

Q: Why are ACP's surveys important to the process?

A: CMS accepts the great majority of the RUC's recommendations; this is based largely on the notion that they reflect a collective decision by a diverse group of physicians as to the relative value of one service compared to all others. Thus, the RUC process requires participation from all specialties.

All physicians are best served when all specialties actively convey the work and overhead involved in their respective, commonly furnished services. Since the surveys are the primary source of data used to determine RVUs, it is essential that ACP members complete surveys so that the College has the information to optimize its participation.

Since many commercial health insurers, Medicaid and state workers' compensation programs use the RBRVS as the basis of their own fee schedules, involvement has implications beyond Medicare.

Q: Who is chosen to participate in a RUC survey?

A: In almost all cases, the survey samples are chosen from among the specialty society's membership rolls. While the RUC provides some discretion in how specialties identify survey participants, ACP typically selects a random sample.

Members should watch their e-mail for an ACP survey. It is vitally important to complete it. ACP needs a strong response rate and reliable data so that the College's recommendations survive the scrutiny of RUC and CMS review. It is also important to remember that these surveys are the primary mechanism for internists to have an expert voice in determining RBRVS values that are used by Medicare and other payers.

Q: Is the government looking at my answers?

A: CMS will see aggregate statistical results, but not individual responses. Nor will the agency receive personal or demographic information. While the RUC reserves the right to review actual completed surveys, all personal information is kept confidential.

Q: Is there a way for me to learn how to answer a RUC survey?

A: Yes, there is an online tutorial that explains how to complete a RUC survey form. Members can view the tutorial at ACP's Running a Practice section.

Members interested in participating in RUC surveys can contact Debra Lansey at (800) 523-1546, ext. 4544, or by e-mail. Debra Lansey ACP will maintain a list, as the RUC rules allow ACP to survey a self-identified pool of respondents.

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Additional resources

More about the RUC process (and its companion, the CPT code process) is available from the following sources.

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