Health Policy Update

On Saturday April 26, the RBRVS Update Committee (RUC) of the AMA met in Chicago. Our business before the RUC consisted of the "site of service anomaly" codes that had been deferred from the February RUC meeting. These codes were being revalued because the Medicare database indicated that they were performed primarily as outpatient procedures even though they contain value for inpatient work. All the orthopaedic site of service codes presented at the February meeting lost all the value associated with their inpatient work representing anywhere from a 4 to 13 percent decrease in reimbursement rate. Our presentation before the RUC last week was much more successful thanks to the work of William R. Beach, MD and William Creevey, MD of the Orthopaedic Trauma Association. The code that we focused on was ACL reconstruction, 29888. All the codes presented at this meeting, including 29888 retained their current value. This we considered a significant victory as ACL was at great risk to lose value and is considered by AANA representatives to the AAOS as undervalued at 14.14 RVW’s. Much thanks to Drs. Beach and Creevey!

The RBRVS system was initially set up to increase the value of cognitive work performed by physicians. Through the RUC, it has been successful in this goal at the expense of our surgical fees. The composition of the RUC has allowed for a more level playing field over the last few years. As a result, we have been relatively successful in getting fair values, especially for new codes, in the recent past. Our experience lately has been decidedly mixed with both good and bad results. However, the RUC process is under intense scrutiny from MedPac, the Congress and the family practice lobby. As a result, the RUC’s very continued existence is in question. The RUC process has been attacked as biased, subject to outside interference and inconsistent. There will be considerable debate concerning the future of the RUC, both inside and outside of the committee in the next few months. It is probably in our best interest to be involved in this process as we at least have a place at the table. The unfortunate alternative to the RUC is for CMS to allocate RVW’s for CPT codes on its own.