relative value system update committee (ruc) amda efforts charles crecelius md phd facp cmd
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Relative Value SystemRelative Value SystemUpdate Committee (RUC) Update Committee (RUC)
AMDA EffortsAMDA Efforts
Charles Crecelius MD PhD FACP CMD
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Relative Value SystemRelative Value SystemUpdate CommitteeUpdate Committee
• RBRVS – – Resource Based Relative Value Scale– Relative value of medical services – RVU = relative value unit
• RUC – Committee that suggests RVU to CMS– 29 voting members, 114 Advisory Committee members
• Utilized by Medicare and also other payors• RVU determined by survey process of time and
intensity of work, presented and voted on by RUC• NH codes surveyed & presented by AMDA
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2008 $$ Reimbursement2008 $$ Reimbursement
Code Nursing
Home
Office Hospital Home
Care
99xx1 19.02
99xx2 37.08 36.13 34.92 49.77
99xx3 56.90 58.21 62.36 74.94
99xx4 75.99 87.59 89.43 109.52
99xx55 111.34 118.57 153.46
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AMDA RUC InvolvementAMDA RUC Involvement
More than just getting more money for nursing home work
• Keeping track of general payment issues
• Being involved in trends in payment
• Collaborating and networking with others– Payment, quality issues– Allied issues
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Medicare Administrative CarriersMedicare Administrative Carriers
• Will replace Fiscal Intermediaries / Medicare Carrier (as part of MMA)
• 15 Medicare A/B Jurisdictions• 4 DME Jurisdiction• 4 Home Health & Hospice Jurisdictions• Critical areas: customer service, operational
excellence, financial management, consistency, competition
• Full transition by Oct 2009
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1 = Palmetto3 = Noridian Administrative Services 4 = Trailblazer Health Enterprises5 = Wisconsin Physician Services 12 = Highmark Medicare Services
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Jurisdiction States Included in Jurisdiction
A Connecticut, Delaware, District of Columbia, Maine, Maryland, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island, and Vermont
B Illinois, Indiana, Kentucky, Michigan, Minnesota, Ohio, and Wisconsin
C Alabama, Arkansas, Colorado, Florida, Georgia, Louisiana, Mississippi, New Mexico, North Carolina, Oklahoma, Puerto Rico, South Carolina, Tennessee, Texas, U.S. Virgin Islands, Virginia, and West Virginia
D Alaska, American Samoa, Arizona, California, Guam, Hawaii, Idaho, Iowa, Kansas, Missouri, Montana, Nebraska, Nevada, North Dakota, Northern Mariana Islands, Oregon, South Dakota, Utah, Washington, and Wyoming
DME MAC Jurisdictions
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Jurisdiction States Included in Jurisdiction
A Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island, &Vermont
B Colorado, Delaware, District of Columbia, Iowa, Kansas, Maryland, Missouri, Montana, Nebraska, North Dakota, Pennsylvania, South Dakota, Utah, Virginia, West Virginia, & Wyoming
C Alabama, Arkansas, Florida, Georgia, Illinois, Indiana, Kentucky, Louisiana, Mississippi, New Mexico, North Carolina, Ohio, Oklahoma, South Carolina, Tennessee, & Texas
D Alaska, American Samoa, Arizona, California, Guam, Hawaii, Idaho, Michigan, Minnesota, Nevada, New Jersey, New York, Northern Mariana Islands, Oregon, Puerto Rico, U.S. Virgin Islands, Wisconsin, & Washington
Home Health & Hospice MAC Jurisdictions
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Patient Centered Medical HomePatient Centered Medical Home
• Physician coordinated care– Personal physician – Physician directed medical practice– Whole person orientation – Care is coordinated and/or integrated– Quality and safety– Enhanced access to care – Payment to support the PC-MH
• Supported by technology, systems, EBP• Addresses high care / chronic care needs • Three tiers of involvement
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Medical HomeMedical Home
• Supported by ACP, AAFP, AAP, AOA
• AMDA’s interest primarily AL
• RUC being asked to propose payment– Reimbursement: FFS, PPS, P4P– Workgroup will include geriatricians– Rapid deadlines
• June 2008 for payment proposal• January 2009 for actual implementation
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CollaborationCollaboration
• Variety of issues with AGS
• Closer relationship with ACP, AAFP– Met with AAFP re: role of attending physician
in the nursing home– Discussing Nurse Practitioner – Physician
scope of practice issues in LTC with AMA, ACP, AAFP
– Supported additional primary care seat on RUC (AGS, ACP, AAFP)
– Networking with other committee via RUC