Transcript Insert Session Title

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
– 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 $$ Reimbursement
Code
Nursing
Home
99xx1
Office
Hospital
Home
Care
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
99xx5
111.34
118.57
153.46
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
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
1 = Palmetto
3 = Noridian Administrative Services 4 = Trailblazer Health Enterprises
5 = Wisconsin Physician Services 12 = Highmark Medicare Services
DME MAC Jurisdictions
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
Home Health & Hospice
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
Patient 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 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
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