The Oct. 27 edition of the Wall Street Journal published an article entitled, “Physician Panel Prescribes the Fees Paid by Medicare”, which provides an overview of the Relative Value Scale Update Committee (RUC). The RUC Panel is convened three times a year by the American Medical Association (AMA) to provide recommendations to the Centers for Medicare and Medicaid Services (CMS) as to how the physician piece of the Medicare payment is determined.

The article details the RUC process and provides insight into a complex payment process. From a specialty society perspective, the RUC process has at times pitted specialty societies against each other when there is an appearance that higher relative payment units (RVUs) are proposed to CMS (by the RUC) for procedures performed by one specialty and a service with apparently comparable physician work performed by another specialty is assigned a lower relative value.

The mechanism used to determine physician work involves a survey of physicians where the time, stress and skill of the physician are estimated related to each service being surveyed. The AASM along with other specialties whose members provide sleep medicine services recently conducted a survey of the Sleep Medicine Codes found in the CPT code book as part of the RUC process. The survey results were presented to the RUC Committee at their April 2010 meeting. It is anticipated that the Federal Register Final Rule (due out in November) will announce CMS’ payment determinations for all the codes reviewed during the three RUC meetings that occur in the cycle used to set Medicare fees for 2011. Payments for the remaining CPT codes that were not surveyed during this past RUC cycle are also contained in the Medicare fee schedule.

The Center for Public Integrity and PharmPro published articles this week related to the story reported by the Wall Street Journal.