Statement attributable to Peter K. Smith, M.D., chair, RVS Update Committee (RUC) “The future success of Medicare depends in part on accurately assessing the constant evolution of science and technology and its impact on patient care. The explosion in health care advances changes the work of physicians over time, so Medicare physician payments need to mirror the change. “Ultimately, there is no substitute for relying on input from experienced physicians when gauging how much work, time and resources go into one medical service compared with another. No one knows more about what is involved in providing services to Medicare patients than the physicians who care for them. This unique insight makes the RUC the best option to review medical services to see whether they are appropriate, undervalued or overvalued. “To date, the update committee has recommended decreases or deletion to more than 1,300 services, leading to nearly $5 billion in annual redistribution to other physician services, including services performed by primary care physicians. Notably, the RUC has led the initiative to identify and value care management and other primary care services not previously paid. “Medicare holds the advice of the 31 volunteer physicians on the update committee in high regard because they apply an evidence-based approach that produces fair and objective recommendations. Far from being secretive, more than 300 physicians and other health care professionals are involved in the process and the RUC’s recommendations and votes are publicly available on the AMA website. “By tapping into the front-line knowledge of physicians, Medicare gains credible insights into the complexities of patient care, and at no cost to taxpayers. As Medicare's ultimate decision maker, the Centers for Medicare & Medicaid Services (CMS) has a seat at the table during all of the committee's discussions, but it is not obligated to accept any of the committee's recommendations. “The RUC welcomes a critical review of its recommendations by CMS and encourages suggested improvements in its processes. If there is a specific criticism of an individual RUC recommendation, the public is able to comment to CMS directly. Those that wish to provide comments should focus their efforts on individual codes as the RUC reviews the resources for individual services. The RUC does not differentiate its review or processes by specialty. “The truth is that the RUC does not control the Medicare payment system, nor does it set rates for medical service. The regulatory process affords hospitals, home health agencies, nursing homes, private health insurers and others the same opportunity that the RUC has to provide input into the policies that determine Medicare payment rates. Yet only physicians are singled out for criticism when making recommendations in a manner so organized, thorough and accurate that those recommendations often are accepted.”