These relative value units are then multiplied by a monetary conversion factor determined by CMS, taking into account the variability of resource costs depending on where in the country services are performed.
“We’re estimating what services are worth relative to what is already valued, and it’s important to establish the precision of those values,” Dr. Laing says.
Once the committee determines the value of a CPT code, it sends a recommendation to CMS. The agency accepts most of the committee’s recommendations but disagrees about 20% of the time, Dr. Laing says. For example, RUC recommended a higher value for in-office dual-energy X-ray absorptiometry scans than the CMS ultimately implemented.
A Seat at the Table
RUC members must stay impartial, which sometimes means recusing themselves from making recommendations for codes used by their society or field. But as a member on a rotating seat, Dr. Laing is able to serve as an advisor in the off-years between serving on the RUC itself. In that role, he can work with other ACR leaders to help advocate during the RUC process.
Volunteering for the committee is an investment of significant time and energy, Dr. Laing adds, but it helps ensure that rheumatology and the ACR maintain a seat at the table. It also helps him stay current on national payment policies and build relationships, which often lead to ACR involvement in other important efforts on behalf of rheumatologists and medicine more broadly. For example, his work with the AMA has connected him to a variety of ad hoc coalitions and led to his participation in the American College of Physicians Subspecialty Advisory Group on Socioeconomic Affairs.
The RUC seat also fosters goodwill for the ACR by demonstrating that the society is willing and able to take an active role in the medical community.
“Overall, the goal is sustainability of our profession,” says Dr. Laing, who has practiced for 31 years. “As my generation retires, our workforce is going to be woefully short. We know students choose professions at least in part based on economics. We need to create a sustainable model so that our workforce is equivalent to the demand. I’m trying to help the society as best I can.”
Kelly April Tyrrell writes about health, science and health policy. She lives in Madison, Wis.
Reference
- Centers for Medicare and Medicaid Services. CMS Office of the Actuary Releases 2018 National Health Expenditures. https://www.cms.gov/newsroom/press-releases/cms-office-actuary-releases-2018-national-health-expenditures. Published Dec. 5, 2019. Accessed March 2, 2020.
