The AMA is embedded in the Medicare payment process. Thomas Scully said the AMA's Resource Value Update Committee (RUC) did a good job for their members by taking over the process, but the RUC became too powerful, very political and "very responsive to stronger specialty groups" and limits the ability of the SGR to work.
Suggested fix. Scully suggested removing the RUC from the AMA and letting it operate as an independent body "through a contractor reporting to the CMS directly." He says it appears the current CMS team is asserting itself more to "make the RUC truly advisory. CMS and objectivity should be driving valuations, not physician politics."
The relative value unit system is really a relative estimated average cost system. McClellan said the RVU system assigns the same value to a service regardless of whether it's of lifesaving value to a patient or no value at all, that it's tough to keep the system up to date with medical technology, and that new services such a e-mail consultations, and nurse- or pharmacist-led care management teams may not be covered at all.
Suggested fix. McClellan, who is a physician himself, said the first step is leadership from the physician community. "Who knows better the best opportunities to improve care and avoid unnecessary costs for Medicare patients that are not well supported by Medicare's currents payment systems?" The second step is to translate clinical opportunities for improving care into Medicare payments reforms that better support patient-centered care. He said that means identifying current payment rules in the fee-for-service system that don't do as much as they could to promote efficient high-quality care.