AAFP stays in the RUC
The American Academy of Family Physicians (AAFP) has decided to continue its participation with a committee that helps to determine how much the government pays doctors despite that committee's rejection of most of AAFP's demands.
Last summer, the AAFP sent a letter to the American Medical Association/Specialty Society Relative Value Scale Update Committee, known as the RUC, with five demands that the AAFP believed would provide greater equity for primary care services by altering the committee's structure, processes and procedures.
[See also: AAFP seeks changes from the RUC.]
The AAFP asked the RUC to respond to its letter by March 1 of this year. The RUC has responded, announced the AAFP yesterday. Most of its demands were rejected.
"We're disappointed and frustrated that their response did not in some ways substantially meet our request," said Glen Stream, MD, AAFP president. "Our decision to remain in the RUC is not at all because we are satisfied with their response, but at the end of the day, our interest is what efforts on behalf of our members are going to have the best traction strategically in getting better payment for primary care services."
The organization, which represents primary care providers across the country, asked the RUC for four additional primary care seats on the committee, a new seat for geriatrics, removal of three rotating subspecialty seats, greater voting transparency and the addition of three new seats for external representatives such as consumers, employers and health plans.
The RUC denied all the AAFP's requests except agreeing to add a seat for geriatrics and it added one new primary care rotating seat.
[See also: RUC adds two new members.]
The RUC also has agreed to alter its voting procedure slightly but not in the manner the AAFP asked. The AAFP asked that everyone at the table would know how everyone else voted so that it would be apparent to all if people were voting in self-interest, said Stream. Instead the RUC has said it will make public the vote totals for each category after the Medicare physician fee schedule is published, a move Stream says does nothing to foster transparency.
Over two days of discussions, the board decided last week to not go through with its threats to exit the RUC, although such a move is not off the table in the future, Stream said. "I think in the end, it wasn't at all a discussion of are we satisfied with the response of the RUC – very clearly we are not satisfied – but are we going to have better success on behalf of our members and the patients they serve, improving primary care payment, by being inside or outside the process. We decided it was inside."
In a statement, Barbara Levy, MD, chair of the RUC, said that the members of the RUC are "pleased" that the AAFP will continue participating, but at least one critic thinks the AAFP has made a serious mistake.
"What they've decided is they'd rather be at the table than not, which means functionally that they continue to legitimize the process that has compromised them and that they enable it. I think it's a serious mistake," said Brian Klepper, PhD, a vocal critic of the RUC who runs a primary care clinic development firm and who serves on AAFP's Primary Care Services Valuation Task Force.
Klepper believes that the RUC has outmaneuvered the AAFP leadership and that the RUC's concessions do not change the balance of power. "This is the moment that shows primary care's leadership has lost its way."
Stream acknowledges that the balance of power hasn't shifted within the RUC, but says that AAFP's board will go around the RUC by taking its recommendations directly to the Centers for Medicare & Medicaid Services (CMS), the agency the RUC advises on physician payment.
"Some of the engagement over this past year with the RUC is their both describing what they can and can't but also what they will and won't do to change their procedure and process around valuing primary care services," Stream said. "And for those things where they say they can't help us it's only natural to say, 'well, we'll help ourselves.' So go around this process. I don't know whether they'll be upset about it or not … (but) they can't expect that we're simply going to accept that answer from them. We're going to continue to do those things that we think are appropriate and necessary both within the RUC but also outside the RUC."
Follow HFN associate editor Stephanie Bouchard on Twitter @SBouchardHFN.
