1 / 11

Relative Value System Update Committee (RUC) AMDA Efforts

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

cadman-hodges
Download Presentation

Relative Value System Update Committee (RUC) AMDA Efforts

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Relative Value SystemUpdate Committee (RUC) AMDA Efforts Charles Crecelius MD PhD FACP CMD

  2. 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

  3. 2008 $$ Reimbursement

  4. 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

  5. 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

  6. 1 = Palmetto 3 = Noridian Administrative Services 4 = Trailblazer Health Enterprises 5 = Wisconsin Physician Services 12 = Highmark Medicare Services

  7. DME MAC Jurisdictions

  8. Home Health & Hospice MAC Jurisdictions

  9. 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

  10. 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

  11. 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

More Related