Relative Value SystemRelative Value SystemUpdate Committee (RUC) Update Committee (RUC)

AMDA EffortsAMDA Efforts

Charles Crecelius MD PhD FACP CMD

Relative Value SystemRelative Value SystemUpdate CommitteeUpdate 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

2008 $$ Reimbursement2008 $$ Reimbursement

Code Nursing

Home

Office Hospital Home

Care

99xx1 19.02

99xx2 37.08 36.13 34.92 49.77

99xx3 56.90 58.21 62.36 74.94

99xx4 75.99 87.59 89.43 109.52

99xx55 111.34 118.57 153.46

AMDA RUC InvolvementAMDA 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

Medicare Administrative CarriersMedicare 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

1 = Palmetto3 = Noridian Administrative Services 4 = Trailblazer Health Enterprises5 = Wisconsin Physician Services 12 = Highmark Medicare Services

Jurisdiction States Included in Jurisdiction

A Connecticut, Delaware, District of Columbia, Maine, Maryland, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island, and Vermont

B Illinois, Indiana, Kentucky, Michigan, Minnesota, Ohio, and Wisconsin

C Alabama, Arkansas, Colorado, Florida, Georgia, Louisiana, Mississippi, New Mexico, North Carolina, Oklahoma, Puerto Rico, South Carolina, Tennessee, Texas, U.S. Virgin Islands, Virginia, and West Virginia

D Alaska, American Samoa, Arizona, California, Guam, Hawaii, Idaho, Iowa, Kansas, Missouri, Montana, Nebraska, Nevada, North Dakota, Northern Mariana Islands, Oregon, South Dakota, Utah, Washington, and Wyoming

DME MAC Jurisdictions

Jurisdiction States Included in Jurisdiction

A Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island, &Vermont

B Colorado, Delaware, District of Columbia, Iowa, Kansas, Maryland, Missouri, Montana, Nebraska, North Dakota, Pennsylvania, South Dakota, Utah, Virginia, West Virginia, & Wyoming

C Alabama, Arkansas, Florida, Georgia, Illinois, Indiana, Kentucky, Louisiana, Mississippi, New Mexico, North Carolina, Ohio, Oklahoma, South Carolina, Tennessee, & Texas

D Alaska, American Samoa, Arizona, California, Guam, Hawaii, Idaho, Michigan, Minnesota, Nevada, New Jersey, New York, Northern Mariana Islands, Oregon, Puerto Rico, U.S. Virgin Islands, Wisconsin, & Washington

Home Health & Hospice MAC Jurisdictions

Patient Centered Medical HomePatient Centered Medical Home

• Physician coordinated care– Personal physician – Physician directed medical practice– Whole person orientation – Care is coordinated and/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

Medical HomeMedical 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

CollaborationCollaboration

• 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