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Relative Value System Update Committee (RUC) AMDA Efforts. Charles Crecelius MD PhD FACP CMD. Relative Value System Update Committee. RBRVS – Resource Based Relative Value Scale Relative value of medical services RVU = relative value unit RUC – Committee that suggests RVU to CMS

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relative value system update committee
Relative Value SystemUpdate 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
amda ruc involvement
AMDA 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
medicare administrative carriers
Medicare 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
slide6

1 = Palmetto

3 = Noridian Administrative Services 4 = Trailblazer Health Enterprises

5 = Wisconsin Physician Services 12 = Highmark Medicare Services

patient centered medical home
Patient Centered Medical Home
  • Physician coordinated care
    • Personal physician
    • Physician directed medical practice
    • Whole person orientation
    • Care is coordinatedand/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
medical home
Medical 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
collaboration
Collaboration
  • 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
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