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AAFP Calls For Revisions to RVU Formula

Cheryl Clark, for HealthLeaders Media, July 25, 2011

"But even when those were designed, people were saying, we're just not good about getting to the 'thinking' part of what happens in that office. If you talk at length with a patient, for example. Or how much is it worth that I counsel you on not only your cough, but I also spend time talking about what to do about your smoking...which compounds the weight problem you have, and how weight affects your diabetes."

The doctor who gives the good physical exam is worth it for the payers and for patients, she explains. "Take someone who comes in with shoulder pain. The PCP would likely spend some time taking a complete history, asking what are the things you have been doing, could it be musculoskeletal, was there trauma or a fall, or could it be a heart or lung problem, or gastrointestinal? There's a multitude of potentials."

Isolating the problem as musculoskeletal early avoids sending the patient to the cardiologist, the gastroenterologist, the pulmonologist.

The issue is getting traction from Congress as well. The RVU is reviewed by the American Medical Association's 29-member RUC or Relative Value Scale Update Committee. But that committee, whose members are primarily procedural specialists, is under fire from Rep. Jim McDermott (D-WA), who also is a physician.

McDermott's 2011 proposed legislation, HR 1256, calls for the Centers for Medicare & Medicaid Services to pay for a "second opinion" of the RUC's determinations related to changes to the CPT billing codes used by all physicians to submit claims.

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2 comments on "AAFP Calls For Revisions to RVU Formula"


Marilyn Masick (7/25/2011 at 10:50 AM)
The RVU's were developed, and include the work expense component. This, combined with the Medicare points system and the CPT levels of E and M, codes result in the cognitive function being included. This is already a part of the current E and M documentation system. Adequate and appropriate training on E and M would be good for someone who doesn't understand how that works.

Jacob Kuriyan (7/25/2011 at 9:41 AM)
Improving reimbursements to all doctors who provide time consuming "cognitive" services in a "[INVALID]ive manner" is desirable. I go beyond family practitioners and include neurologists, for example, in this preferred group. Simply paying more for a particular procedure code ( as we do currently) will not work as it will also reward specialists who use such codes, whether they provide time consuming cognitive services or not. There is a serious omission in the article. The origin of this disparity can be laid at the feet of primary care physicians and their professional groups. When the California Medical Association invited physicians to participate in designing RVS codes (precursor to CPT codes in use today) only specialists showed any interest in working on it. With few if any PCPs involved it is no surprise that "procedure" based practices were amply rewarded. Once adopted by insurers, California suregeons saw their incomce sky-rocket compared to their PCP colleagues. There is a lesson to be learned here. Organizations like AAFP must play an active and positive role in health reform related activities (ACOs, PCMHs etc.) and not sit on the side-lines complaining about "Obamacare". They should focus on PCP issues and figure out a way to help them thrive under health reform initiataives.