As obstetricians—gynecologists, we got into the field of obstetrics and gynecology because we’re passionate about women’s health. We’re naturally curious people who love that this great specialty covers everything from surgery to bringing new life into the world. As the health care landscape changes with new technology and new business models, it’s critical that we understand how payment models are decided and the ways in which ACOG and you are involved in the process.
In 1992, Congress transitioned to a physician payment system based on a resource-based relative value scale, which mandated that payment for services be based upon the resources required to perform a service and the related practice expense. The AMA subsequently formed the Relative Value Scale Update Committee (RUC), which advises the Centers for Medicare & Medicaid Services on the relative value units (RVUs) that should be assigned to new or revised codes in the Current Procedural Terminology codebook. Although the RUC provides the work RVU recommendations, CMS makes the final decision on the RVUs, even for services they don’t cover. Today, you may know the RUC as the group responsible for the often murky process of reimbursement for procedures and services. But do you know ACOG’s role in the RUC?
The RUC is primarily comprised of representatives for specialties that accept payment through Medicare. Membership was initially determined by the amount of Medicare expenditure in certain specialties. Though obstetricians—gynecologists and pediatric physicians make up a smaller portion of Medicare expenditure, they also have RUC seats because their services are essential. ACOG has a permanent seat on the RUC. This means that when the RUC decides on recommendations for RVUs, which determine reimbursement rates, ACOG is right there at the table, advocating for obstetricians and gynecologists and women’s health care physicians. Barbara Levy, MD, ACOG’s vice president of health policy, served as RUC chair for six years and recently appeared in a three-episode series of ACOG’s CHEC Your Practice podcast to explain RVUs and the RUC in depth.
So, how is reimbursement determined? The process begins when the RUC sends out a randomized survey that gauges how much time physicians spend on certain procedures and services, including preservice and postservice time. Based on the survey results, the RUC presents analyzed, aggregated survey data in the form of RVU recommendations to CMS, which then takes those recommendations into account when determining a code’s final RVUs. From there, the CMS contributes additional data, such as data from their personal database on the length of hospital stays, which brings in a different perspective.
Have you noticed changes to reimbursements for certain procedures? A large part of this may be due to technological advances that make procedures quicker and easier. For example, laparoscopies, which used to include two days of hospital stay on top of the time it took to do the procedure itself, are now usually outpatient procedures. In past code reviews, a significant amount of RVUs were assigned to the amount of time spent in the hospital. Now, because the CMS records shorter hospital stays for laparoscopies, reimbursement payments are lower.
Even though you may not feel represented in the reimbursement process as an individual physician, you and your peers can make an impact on RVU valuation by participating in the RUC survey whenever you receive one. Filling out the RUC survey as thoughtfully as possible helps the RUC get a better understanding of the resources required to perform certain services. Providing the most accurate responses to the survey is extremely important; for example, Dr. Levy notes that surgeons tend to think of themselves as “fast and efficient” and may not consider the amount of time a service takes to complete. In the end, says Dr. Levy, the “determination of RVUs . . . what we as ACOG can present to the RUC is only as good as the survey data we get from ACOG members.” Let’s do this!