Dr. John Proctor, MD, MBA, FACEP, FAAP is an emergency physician and voting member of the AMA RUC, Revenue Value Scale Update Committee. Dr. Proctor gave a presentation and answered questions about the mysterious and all-powerful RUC to IEPC leaders during the February meeting.

The RUC was established by the AMA in 1992 and establishes relative values of RVUs for CPT codes to CMS. Historically, over 90% of the recommendations are accepted by CMS. The RVU as 29 voting members, a non-voting chair, and two non-voting member. To dispel myths of the power of the surgical sucspecialties, 10 out of 29 members come from surgery.

The benefits of the surgical subspecialties is that they can claim higher operational costs than hospital-based physicians by including staff and equipment expensive that hospital-based physicians allegedly do not have.

The RUC does not set prices, but it does determine relative value, RVU, of different services. A structure repair performed by an emergency physician, a plastic surgeon, or a family practice office all have the same CPT code and relative value. However, a plastic surgeon may have additional CPT codes or office expense codes.

The RUC and RVU process does not account for the federal mandate on emergency providers that results in a significant percent of unpaid services. The process also does not account for the increasing complexities of job an emergency physician over the years – dealing with complicated transfers, complicated discharge order to SNF, or observation of psychiatric patent for days.

There is opportunity for emergency physicians to bill for services like hospitalists and primary care physicians such as screening and brief intervention to treatment for addiction and end-of-life discussions with patients and family.