William D. Donovan
I was recruited to the payment policy field by my mentor, friend, and former ASNR President Bob Zimmerman (the New York Bob) in 2006. I had made him a standing offer to help ASNR out however he thought best. When he asked if I wanted to help out Bob Barr with the RUC, I replied, “Sure, Bob—what’s the RUC?” It’s clear I was not alone in my ignorance, then or now; I’ve heard that response many times since. I was honored to represent ASNR to that body for several years, thanks to Bob Barr’s coaching, and have served the past few years as an Alternate Member of the RUC, representing the specialty of radiology.
This article is a brief synopsis of the RUC and its key position in the Medicare payment policy system in terms I thought most radiologists could understand. To this day, the RUC remains centrally important, not only with regard to physician payment but also in practice expense reimbursement. This role may change in the expected evolution from volume-based medicine to value-based care; but the numbers that the RUC generates—the Relative Value Unit recommendations to CMS, by which all medical and surgical work is measured—will probably be the basis for whatever future medical payment system is created.
There have been some changes in the composition of the RUC since this article originally appeared. Most notably, 4 physician seats dedicated to primary care were added to the Committee beginning in 2012, largely due to pressure from MedPAC and outside influencers. Medicare has continued to accept fewer RUC recommendations wholesale, tweaking the numbers in its Final Rules to a greater degree than in the 1990s and 2000s. The intense scrutiny of imaging reimbursement has continued at the RUC, largely due to Medicare “requests,” despite recent data showing that imaging is no longer a primary driver of health care budget growth.
For those interested in a more detailed review article regarding neuroradiology reimbursement, I later published an article solicited by Dave Yousem for a socioeconomics-themed edition of the Neuroimaging Clinics of North America, “The Resource-Based Relative Value Scale and Neuroradiology: ASNR’s History at the RUC” (2012, vol. 22, no. 3).