A RUC Rescue of Primary Care?

Primary care faces an existential challenge brought on by chronic underpayment for primary care services. Fundamental payment reform and major new investment in primary care are urgently needed, but progress in implementation has been slowed by budget neutrality and resistance from the specialty community. The AMA-sponsored and specialty-dominated RBRVS Update Committee (RUC) has been part of the problem, undervaluing primary care services and overvaluing specialty procedures in its RBRVS value recommendations (RVUs) to Medicare. These RVU determinations are critically important because they serve as the basis for almost all physician payment, not just for Medicare. Correction of the RUC's methodologic flaws, conflicts of interest, and skewed membership could make the RUC part of the solution. Proposed is a RUC-based initiative to address these shortcomings in the revaluation of primary care services. A RUC-initiated taskforce approach with equal primary care and specialty representation is recommended for the revaluation mission, addressing previous RUC shortcomings and reporting out new RVU determinations within 12 months. Going the RUC route has advantages along with obvious barriers and pitfalls, which are discussed along with the means of dealing with them.