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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

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Relative Value System Update Committee (RUC) AMDA Efforts

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  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

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