AAPM&R recognizes that many members may not be familiar with how payers determine the amount they should reimburse for each service. As payment has declined in recent years, these seemingly arbitrary cuts cause frustration. We advocate for fair reimbursement by providing input to the American Medical Association’s (AMA) Relative Value Scale Update Committee (RUC), which is one of the key processes by which the Centers for Medicare & Medicaid Services (CMS) determines how to value services.
Permanent Seat on RUC
AAPM&R is thrilled to announce that on January 16, 2021, for the first time, PM&R earned a permanent seat on the American Medical Association (AMA) Relative Value Scale Update Committee (RUC). This decision was confirmed by a two-thirds majority vote at the RUC meeting on January 16. We owe this huge victory to the outstanding efforts of the AAPM&R RUC team. Matthew Grierson, MD, FAAPMR, laid the groundwork by previously winning an election to hold a position on the RUC’s rotating seat and just completed a two-year term along with his alternate, Clarice Sinn, DO, FAAPMR.
Drs. Grierson and Sinn will continue to serve on the RUC, holding PM&R’s permanent seat beginning in March. In addition to Drs. Grierson and Sinn, PM&R is represented at the RUC by an advisor Carlo Milani, MD, MBA, FAAPMR and alternate advisor David Reece, DO, FAAPMR. Dr. Milani, with the support of the entire AAPM&R RUC team, tirelessly fielded questions and deliberated with RUC leaders from numerous medical specialties as they weighed the decision to award the seat to PM&R.
For years, PM&R was one of a very few American Board of Medical Specialties (ABMS)-recognized specialties to not have a seat on the RUC. Until 2018, we did not meet a set of five eligibility criteria. Nonetheless, we have remained active in the AMA RUC since its inception, representing the interests of physiatrists and working diligently over the last several years to earn a permanent seat. Earning the permanent RUC seat is a direct result of the passion of our volunteer leaders, their engagement in the AMA process and their keen understanding of the importance of the RUC in today’s reimbursement environment. Congratulations and thank you to our entire RUC team for their diligence and commitment on behalf of the specialty!
“There has been a team of physicians and staff from the AAPM&R working to propel our specialty forward nationally for many years, which to this point has culminated in Dr. Matthew Grierson and Dr. Clarice Sinn earning a permanent seat at the RUC. This win is due to the efforts of Team Physiatry and the ongoing excellence, dedication and integrity that Drs. Grierson and Sinn have brought to their work at the RUC for PM&R over the past two years,” said Dr. Milani.
Why the RUC Seat Matters
The RUC is one of the key processes by which the Centers for Medicare & Medicaid Services (CMS) determines how to value services. Its recommendations to CMS can be accepted, rejected or modified. These decisions have a ripple effect throughout the private insurance market and can affect compensation. Holding a RUC Seat will promote the visibility of PM&R in the House of Medicine and also gives our specialty a voice in deliberations about the valuation of codes presented to the RUC.
"When there is no physiatrist perspective for these major policy making bodies, it is no wonder that some of our colleagues do not understand the value of or perspective of our specialty. Having a permanent seat improves the quality of the deliberations because there is no other specialty out there whose primary focus is on patient function," said Dr. Grierson.
“This is an historic moment for the field of physiatry. It puts physiatry at the forefront of physician reimbursement. Our colleagues on the RUC see the value physiatrists bring to the table in giving us a permanent RUC seat. It is important for our voices to be heard when discussing values for CPT codes, as it ultimately affects how our members will get reimbursed. We may be a smaller community when compared to other specialties, but our opinions matter!” said Dr. Sinn.
Send a Note of Thanks
Extend a note of appreciation and congratulations to Drs. Grierson, Sinn, Milani and Reece by logging into PhyzForum (members only). Click on the three-dot icon to "Send Message."
Dr. Carlo Milani, Dr. Clarice Sinn, Dr. Matthew Grierson and Dr. David Reece (left to right).
In February/March 2019, a random selection of AAPM&R members participated in a RUC survey focused on E/M reimbursement. For more information on the RUC survey process, please watch the following video: Understanding the RUC Survey Instrument.