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March 8, 2005


March 8, 2005


AMA RUC Rejects Pulmonary Bid for Permanent RUC Seat
At the February meeting of the American Medical Association Resource Based Relative Value Update Committee (AMA RUC), the panel voted against a measure to give the pulmonary specialty, gastroenterology specialty and oncology/hematology specialty permanent seats on the AMA RUC.

The AMA RUC is comprised of specialties and non-physician providers. The purpose of the AMA RUC is to recommend to Medicare the relative value units (RVUs) for the CPT codes developed by the AMA Current Procedural Terminology Committee. Medicare, and other payers, in turn uses the RVU recommendation to establish payment levels for the various CPT codes. Medicare accepts over 90 percent of the AMA RUC recommendations. As such the AMA RUC is an influential committee that has significant impact on Medicare reimbursement for physician services.

The AMA RUC has 29 seats including 21 permanent seats for specialties, 3 rotating seats for specialties that do not have a permanent seat, and 5 seats for non-physician providers and AMA representation.

To be eligible for a permanent RUC seat, a specialty must meet the following criteria:

  1. the specialty is an American Board of Medical Specialties (ABMS) recognized specialty
  2. The specialty comprises 1 percent of physicians in practice
  3. The specialty comprises 1 percent of physician Medicare expenditures
  4. Medicare revenue is at least 10 percent of mean practice revenue for the specialty
  5. The specialty is not meaningfully represented by an umbrella organization, as determined by the RUC.

In response to petition to grant the pulmonary community a permanent seat on the AMA RUC, the AMA RUC passed two motions. The first motion was to “grandfather in� all existing organizations that currently have permanent seat. The second motion was to define specialty as one of the 24 recognized by American Board of Medical Specialty (ABMS).

The first motion was necessary to protect the seats of a several specialties/ subspecialties that have permanent seats but do not meet all five of the existing criteria.

The second motion effectively blocked the efforts of the pulmonary community to earn a permanent seat on the AMA RUC. Because the ABMS considers pulmonary medicine to be a subspecialty of internal medicine, the AMA RUC determined that the pulmonary community did not meet the criteria as an ABMS recognized specialty.

What makes the decision of the AMA RUC ironic is that AMA RUC has previously granted permanent seats to specialties that are subspecialties of internal medicine and have waived other criteria to allow other specialties permanent seats on the AMA RUC.

The pulmonary community, joined by the gastroenterology and oncology/hematology (who were similarly dismissed by the AMA RUC) communities will continue to pursue a permanent seat on the AMA RUC.


ATS Calls on President Bush to Ratify FCTC
This week, the ATS joined over 60 organizations calling upon President Bush to send the Framework Convention on Tobacco Control (FCTC) to the Senate for ratification. As you may recall, the FCTC is an international treaty designed to reduced tobacco consumption and tobacco-related disease around the world. Earlier this year, Peru became the 40th nation to ratify the treaty making the treaty enforceable among all nations that ratified the treaty. Currently over 58 nations have ratified the treaty. The United States is not among them.

The Bush Administration has stated its support for the treaty and has signed the treaty. However, the Administration has not yet indicated if or when the FCTC treaty will be sent to the Senate for ratification. The U.S. is not bound to abide by the treaty until it is ratified by the Senate.


ATS Joins Letter in Opposing Budget Cuts
On February 1, the American Thoracic Society joined over 425 health organizations in a letter to President Bush outlining our concerns with the administration’s fiscal year 2006 (FY06) budget proposal. The FY06 budget proposal proposes a 1 percent decrease in discretionary spending and a five-year freeze on spending at FY06 levels. Of particular interest to the ATS, the FY06 budget asks for a mere .5 percent increase for the National Institutes of Health (NIH) and a 12 percent decrease for the Centers for Disease Control and Prevention (CDC).

The letter stated that our nation’s public health system will not be able to respond adequately to chronic disease, infectious and bioterriorism threats without additional resources for the continuum of medical research, prevention, treatment and training programs.

The letter concluded that an investment now in research and public health funding is critical to improving the health, safety and security of our nation in the future.

In related news, ATS President Dr. Sharon Rounds sent a letter to the congressional budget committee outlining how the FY06 budget is harmful to pulmonary research and public health programs. In the letter, Dr. Rounds urged Congress to provide the National Institutes of Health (NIH) at least $30 billion for FY 2006, a 6 percent increase over fiscal year 2005 (FY05) levels and $8.65 billion, an 8.1 percent increase over FY05 for the CDC. Dr. Rounds stated, “[t]o adequately research, treat and prevent respiratory diseases, it is essential that the funding for the CDC and the NIH maintain a steady growth.�

Specter Decides to Remain as Senate LHHS Chair
In February, Senator Arlen Specter (R-PA) announced his decision to remain as chair of the Senate Labor, Health and Human Services (LHHS) Appropriations Subcommittee. The Senate LHHS subcommittee funds the NIH, CDC and the rest of the Public Health Service. Senator Specter had been considering a move to the newly formed appropriations subcommittee on intelligence.

Senator Specter said, “[t]he president's budget puts at risk critical funding for the National Institutes of Health (NIH) and other important priorities of the subcommittee.� Specter further stated that the gains made by the doubling of the NIH budget may be nullified unless increases in funding continue.

Senator Specter’s decision to remain chair of the LHHS appropriations subcommittee ensures that a strong supporter of NIH funding and other public health programs continues to chair this powerful committee.

Congressional Appropriations Committees Reorganize
On February 8, the House Appropriations Chairman, Rep. Jerry Lewis (R-CA), announced the final plans to reduce the number of appropriations subcommittees from 13 to 10. Eliminated would be Veterans Affairs and Housing Development, with those agencies farmed out to several other subcommittees, Legislative, and District of Columbia subcommittees. The Labor, Health and Human Services and Education subcommittee was not affected in the reorganization plan.

In similar action, the Senate Appropriations committee also organized its subcommittee structure, but chose a different path than its House counterpart. The Senate Appropriations committee dismantled the VA-HUD appropriations subcommittee (which includes the EPA, NSF and NASA programs). The VA programs moved over a reconstituted the Military Construction/Veterans Affairs Subcommittee chaired by Sen. Kay Bailey Hutchison (R-TX). The NASA and NSF got to the revamped Commerce-Justice and Science Subcommittee Chaired by Sen. Richard Shelby (R-AL). The EPA is moved into the Interior Appropriations Subcommittee chaired by Sen. Conrad Burns (R-MT). The Labor Health and Human Services appropriations subcommittee – which funds NIH, CDC and the rest of the Department of Health and Human Services – is left unchanged by the reorganization.

Points of Contact

Gary Ewart Senior Director, Government Relations
Nuala Moore Senior Legislative Representative
Joe Kirby DC Office Administrator