The Specialty Society Relative Value Scale Update Committee or Relative Value Update Committee, (RUC, pronounced "ruck")[1] is a private group of 29 mostly specialist physicians who have made highly influential recommendations on how to value a physician's work when computing health care prices in the United States' public health insurance program Medicare.
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Before the 1992 implementation of the Medicare fee schedule, physician payments were made under the "usual, customary and reasonable" payment model (a "charge-based" payment system). Physician services were largely considered to be misvalued under this system, with evaluation and management services being undervalued and procedures overvalued.[2] Third-party payers (public and private health insurance) advocated for an improved model to replace the UCR fees, which had been associated with stark examples of specialists making significantly higher sums of money than primary care physicians.[3]
With reference to the research of William Hsiao and colleagues,[4] the Omnibus Budget Reconciliation Act of 1989 was passed with the legislative intent of reducing the payment disparity between primary care and other specialties through use of the resource-based relative value scale (RBRVS). However, RBRVS was never fully implemented, partially due to RUC.[5]
RUC was established in 1991 by the American Medical Association (AMA) and medical specialist groups.[6] The AMA sponsors RUC "both as an exercise of 'its First Amendment rights to petition the Federal Government' and for 'monitoring economic trends ... related to the CPT [Current Procedures and Terminology] development process".[7]
RUC is highly influential because it de facto sets Medicare valuations of physician work relative value units (RVUs)[1] of Current Procedural Terminology (CPT) codes.[8] (The Centers for Medicare and Medicaid Services (CMS) is the de jure work RVU determining body.) On average, physician work RVUs make up slightly more than half of the value in a Medicare payment.[7] Historically, CMS has accepted RUC recommendations more than 90% of the time. Health economist Uwe Reinhardt characterized the CMS as slavishly accepting RUC recommendations.[1] The physician work RVU values accepted by CMS also influence private health insurance reimbursement.[7]
In 2002, a RUC update of values raised concerns that the process, which was initatied by medical speciality groups, unfairly cut primary care physician pay.[9]
In a 2010 Archives of Internal Medicine publication written before the major health care reform legislation passed Congress—the Patient Protection and Affordable Care Act (PPACA)—Federman et al. wrote:
Physician dissatisfaction with Medicare reimbursements and concerns about equity of reimbursements suggest that the role of the RUC in advising Medicare should be carefully evaluated. The Obama administration and health policy experts have called for the creation of an independent Medicare advisory committee ... Without an independent arbiter, physicians and physician groups are likely to continue having complaints about the equitability of reimbursements under Medicare.[10]
The Independent Payment Advisory Board passed in the PPACA. It could bypass RUC to cut payments to relatively highly compensated specialists, such as dermatologists.[1][11][12][13][14]