Relative value system update committee ruc amda efforts
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Relative Value System Update Committee (RUC) AMDA Efforts PowerPoint PPT Presentation


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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 (RUC) AMDA Efforts

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Relative Value SystemUpdate Committee (RUC) AMDA Efforts

Charles Crecelius MD PhD FACP CMD


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


2008 $$ Reimbursement


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

  • 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


1 = Palmetto

3 = Noridian Administrative Services 4 = Trailblazer Health Enterprises

5 = Wisconsin Physician Services 12 = Highmark Medicare Services


DME MAC Jurisdictions


Home Health & Hospice MAC Jurisdictions


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

  • 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

  • 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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