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AAFP Calls for RUC Reforms, but Won't Back Suit

John Commins, for HealthLeaders Media, August 12, 2011

A lawsuit filed this week by six Georgia physicians illustrates the growing resentment and anger that primary care providers have with what they say is a secretive Medicare reimbursement process that is skewed towards specialists, says Roland Goertz, MD, president of the American Academy of Family Physicians.

"For a group of physicians to resort to legal action should give you an indication of how frustrated primary care physicians are," Goertz told HealthLeaders Media. "Their feeling is that the system over the last 20 years has not appropriately rewarded them for the care they provide. Nor has it appropriately positioned them for their importance in this system."

In a lawsuit filed this week in U.S. District Court in Maryland, the Georgia physicians, all from the Center for Primary Care in Evans, GA, complain that for nearly 20 years the Department of Health and Human Services and the Centers for Medicare and Medicaid Services have relied on the "specialist-dominated" Relative Value Scale Update Committee (RUC) for reimbursement advice.

The 74-page suit, filed this week in U.S. District Court in Maryland, claims that the RUC violates the Federal Advisory Committee Act's requirements for representation, transparency, and methodological rigor. As a result, the Center for Primary Care physicians claim, the RUC "has systematically overvalued many specialty procedures while undervaluing primary care." The plaintiffs want a federal judge to suspend the RUC process until HHS and CMS comply with FACA rules.