By David O'Brien Jr., MD | Vice-Chair | ISIS Socioeconomic Committee
The days of receiving fee-for-service reimbursement for physician services ended in the 1980's. In 1992 the RUC (Relative Value Update Committee) was established to assign a "value" or an RVU (Relative Value Unit) to each CPT code. Although Medicare has the final authority in approval of the RVUs, in the past decade Medicare accepted more than 95% of the value recommendations proposed by the RUC. In addition, most private payers also utilize the RUC/Medicare-determined RVUs in structuring their physician fee schedules; therefore the RUC process is critical in determining the reimbursement levels for specific procedures.
So what does all this mean for ISIS members and how does ISIS come into the picture in assuring that spinal interventions are reimbursed at reasonable rates?
Over the last decade, ISIS has maintained physician advisor and staff representation at all AMA-CPT and RUC meetings, to advocate for fair coding practices and fair reimbursement levels for spinal interventions. Our members’ interests are represented when decisions about the number of RVUs assigned to each CPT code are made. Over the years, it has taken an incredible effort and time commitment, to assure that ISIS is a known and well respected voice at these forums. ISIS has invested in expert staff and has committed to building bridges and coalitions, which have proven to be invaluable in advocating for the best interest of our patients and our specialty.
Not all "pain societies" have had member and staff representation at the CPT and RUC, where the influence on how interventional procedures are valued, counts the most. Some choose to spend membership dollars on Congressional fundraisers, and lobbying to increase the Medicare budget. While increasing Medicare budget is extremely important, there are many much larger organizations which already do that, and these efforts would be considered just a drop in the ocean of lobbying money already poured in Washington for similar causes. In addition, any increase in the overall budget will benefit all specialties equally. However, it is primarily through proper representation at CPT and RUC that affects the reimbursement our membership receives specifically for interventional pain procedures. ISIS, as a tax-exempt education and research organization is very careful about how our expertise and research can be used to earn respect and power where it really counts, and to have the greatest impact for interventional pain procedures, without wasting member dollars on political donations.
There are many other ways in which ISIS works to influence and maintain appropriate coverage and reimbursement for spinal interventions to assure proper access to quality care for our patients – this is just one example of how important our advocacy has been and ISIS is dedicated to continue this important work for our membership and the patients we serve.