2019 HSC Section 2 - Practice Management

Reprinted by permission of J Am Acad Dermatol. 2018; 78(4):816-820.

H EALTH POLICY & PRACTICE

Future considerations for clinical dermatology in the setting of 21st century American policy reform: The Relative Value Scale Update Committee

John S. Barbieri, MD, MBA, a Harrison P. Nguyen, MBA, MPH, b Howard P. Forman, MD, MBA, c Jean L. Bolognia, MD, d and Scott A. B. Collins, MD e Philadelphia, Pennsylvania; Houston, Texas; New Haven, Connecticut; and Tigard, Oregon The American Medical Association-Specialty Society Relative Value Scale Update Committee, also known as the RUC, plays a critical role in assessing the relative value of physician services and procedures. This committee provides access for all physicians, including dermatologists, to the reimbursement process. Since the introduction of the Resource-Based Relative Value Scale by Medicare, the RUC has done important work to evaluate and refine reimbursement for physician services. The RUC recommendations have also led the Current Procedural Terminology (CPT) Editorial Panel to develop additional reimbursement codes as new procedures and services are developed. In this article (from the series Future Considerations for Clinical Dermatology in the Setting of 21st Century American Policy Reform), we will review the RUC, including its history and membership, the RUC update process, and a brief discussion of a few issues of particular importance to dermatologists. ( J Am Acad Dermatol 2018;78:816-20.) T he American Medical Association (AMA)- Specialty Society Relative Value Scale Update Committee, also known as the RUC, Abbreviations used: AMA: American Medical Association APM: alternative payment model

plays a critical role in assessing the relative value of physician services and procedures. This committee provides access for all physicians, including dermatologists, to the reimbursement process. Since the introduction of the Resource-Based Relative Value Scale by Medicare, the RUC has done important work to evaluate and refine reimbursement for physician services. The RUC recommendations have also led the Current Procedural Terminology (CPT) Editorial Panel to develop additional reimbursement codes as new procedures and services are developed. In this article (from the series Future Considerations for Clinical Dermatology in the Setting of 21st Century American Policy Reform ), we will review the RUC, including its history and membership, the RUC update process, and a brief From the Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia a ; Baylor College of Medicine, Houston b ; Department of Public Health (Health Policy), Economics, and Management, Yale University, New Haven c ; Department of Dermatology, Yale School of Medicine, New Haven d ; and private practice, Tigard. e Funding sources: None. Conflicts of interest: None disclosed. Accepted for publication November 12, 2017.

CPT: CMS:

current procedural terminology Centers for Medicare and Medicare Services geographic pricing cost index

GPCI: RAW:

Relativity Assessment Workgroup RBRVS: Resource-Based Relative Value Scale RUC: Relative Value Scale Update Committee RVUs: relative value units

discussion of a few issues of particular importance to dermatologists.

HISTORY OF THE RESOURCE-BASED RELATIVE VALUE SCALE Before the 1990s, the prevailing practice was for insurers to pay physicians for their services based on what was termed usual, customary, and reasonable

Reprints not available from the authors. Correspondence to: John S. Barbieri, MD, MBA, 2 Maloney, 3600 Spruce St, Philadelphia, PA 19104. E-mail: john.barbieri@uphs. upenn.edu . Published online November 24, 2017. 0190-9622/$36.00 ! 2017 by the American Academy of Dermatology, Inc. https://doi.org/10.1016/j.jaad.2017.11.035

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