Looking to the Future of the AMA RUC

Ezequiel “Zeke” Silva III, MD, FACR, Immediate Past Chair of the American College of Radiology® (ACR®) Commission on Economics, and Chair of the American Medical Association (AMA) Multispecialty Relative Value Scale Update Committee (RUC), contributed this post.

My appointment as Chair of the AMA RUC started March 1. Many — but not all — radiologists know of the RUC and what it does. In this ACR Voice of Radiology blog, I’m excited to share more information on the RUC and provide insight into my goals and aspirations in this new role.

The RUC’s foremost task is to ensure that patients receive the highest quality of care possible and that physicians have the resources to provide that care. The RUC convenes a panel of experts across multiple medical specialties. The panel applies a high level of clinical expertise to identify changes in clinical practice and makes recommendations to the Centers for Medicare & Medicaid Services based on clinical experience and objective data. The result is a credible set of valuation recommendations to help enable the highest level of care possible. 

The RUC has been formulating recommendations for approximately 30 years. As medicine has changed and innovated, so has the RUC. Our nuts-and-bolts task is to help maintain the resource-based relative value scale, which determines relative value units (RVUs). These RVUs are imputed into a broader formula to help determine payment rates with the Medicare Physician Payment Schedule.

The ACR has held a permanent seat on the RUC since its inception, and I am honored to be the first radiologist to hold the position of Chair — but I am certainly not the first to make lasting contributions to the RUC. The list of past radiologists who have done so is long and includes James M. Moorefield, MD, FACR; William T. Thorwarth Jr., MD, FACR; James P. Borgstede, MD, FACR; Bibb Allen Jr., MD, FACR, Geraldine B. McGinty, MD, MBA, FACR; and our current RUC panel member, William D. Donovan, MD, MPH, FACR.

My goal is to translate the innovative mindset, which I have learned in years of service to the ACR, into effective actions from the RUC. The ACR has been a leader in digital technology, and I view digital medicine as an important opportunity for the AMA and RUC. For example, telemedicine, telehealth, remote patient monitoring and digital therapeutics are becoming more commonplace, often informed by augmented intelligence. The RUC will play an important role in defining the taxonomy around these technologies and will influence how payment for these services occurs.

It is important to note that each member of the RUC is an independent participant. We do not represent our respective specialties. In fact, I will, by rule, be excluded from discussions around radiology services to maintain that independence. Nonetheless, I am a diagnostic and interventional radiologist, and the opportunity to carry that title to a position that influences all of medicine is a responsibility I hold dearly.

Have any questions? Let’s talk! Please share your thoughts in the comments section below, and join the discussion on Engage (login required).

Radiology CAC Members Can Have a Big Impact

Sammy Chu, MD, FACR, Chair of the American College of Radiology® (ACR®) Contractor Advisory Committee (CAC) Network, and President of the Washington State Radiological Society contributed this post.

The Medicare Administrative Contractors, affectionately known as the MACs, are the medical insurance companies that actually process Medicare claims from physicians and hospitals. Medicare is such a large enterprise that the federal government contracts out these activities to the MACs, who can set coverage policies for their region called Local Coverage Determination policies, or LCDs. Back in 2019, there were changes to Medicare that provided a formal structure for the various MACs in the country to work together to develop these LCDs. The MACs have always had physician advisors— including radiologists — for their policies, meeting with each MAC in a state-level Contractor Advisory Committee, or CAC.  How would these CACs function on a national level?

In the first “cross-country” CAC, the topic of vertebroplasty and kyphoplasty was discussed. These spinal procedures involve the injection of bone cement into fractured vertebrae. After the MACs and CAC members met in a large national meeting at the beginning of 2019, it took several months before the LCD policies were written up … and it was a disaster. Payment for subacute fractures, which have always been covered and which the medical literature strongly supports, was suddenly stopped. It took several more months and numerous phone calls before these were put back on the payment list.

When your ACR CAC members learned that facet joint injections were to be discussed, we all held our breath. How would things turn out this time? The MACs and CAC members met (virtually, of course) in May 2020, and the literature on the efficacy of these injections for chronic facet pain was discussed. After several hours of heated debate, radiology CAC members were unclear what the new policy would look like. We only found out a couple of weeks ago, and the result was significantly better than the initial vertebroplasty result. The facet joint LCD was what we expected. However, these meetings have revealed upcoming challenges with the new LCD policy development process. The input of radiology CAC members has become diluted with these large national meetings, and more recently, even been shut out completely. The topics of discussion have focused on spinal injections, which form a relatively small portion of most radiology practices. What happens if the MACs turn their attention to imaging protocols? Fortunately, CAC members are still able to voice our concerns with the medical directors of each MAC, and that is how we need to exert our influence. It has never been more important to “act locally,” and we need to recruit engaged radiology CAC members for each state. If you are interested in influencing payment policy, please reach out to Alicia Blakey, ablakey@acr.org, or myself to get involved.

Please share your thoughts in the comments section below and join the discussion on Engage (login required).

A Note to My Future #RadRes Colleagues

Neil K. Jain, DO, IR/DR Resident at MedStar Georgetown University Hospital, and Chair of the American College of Radiology® (ACR®) Medical Student Subcommittee, contributed this post.

In today’s medicine, radiology is ubiquitous. From diagnosing pneumothoraxes on routine chest X-rays to detecting rare forms of renal cell carcinoma on contrast-enhanced ultrasound, radiology is intimately involved in solving many of medicine’s most complex problems. As a future radiologist, you are training to become experts with a unique skillset in imaging which will inevitably guide disease management and treatment.

Radiology is at the intersection of diagnostic and procedural medicine, groundbreaking innovation and patient-centered care. Imagine offering patients lifesaving interventions while maneuvering along the body’s intricate highway system through a miniscule pinhole. Diagnostic and interventional radiology are the future of medicine, and the future of medicine is here.

Each year on Match Day, our specialty continues to grow. Your investment and interest in joining the field of radiology is truly infectious. On behalf of the ACR Medical Student Subcommittee, and more than 40,000 members of the ACR, I would like to extend our warmest congratulations to you and your loved ones for your achievements. As you celebrate and prepare for the next step in your professional journey, we would like to welcome you into our family!

We’re here to support you as you take the next step in your career. Check out the ACR Medical Student Hub for countless resources, including toolkits, blogs, professional development and so much more.

Please share your thoughts in the comments section below and join the discussion on Engage (login required).