STS representatives successfully presented the case for increased relative work values for selected cardiac and thoracic surgery codes to a multi-specialty panel tasked to make recommendations to the Health Care Financing Administration (HCFA). Highlighting data provided by the STS, the panel recommended substantial increases for the reviewed adult cardiac and congenital codes. Three high-volume general thoracic codes were also recommended for significant increases, while an additional nine are slated for review in February. If accepted by HCFA, these changes will mark a significant improvement in Medicare reimbursement for the specialty, counteracting some of the reductions experienced over the last decade.
The AMA Relative Value Update Committee (RUC), comprised of representatives from specialty medical organizations including STS, engages in a process every five years that provides the opportunity for specialties to present their codes for recommended changes in relative work values. STS submitted a total of 98 codes to the RUC for revaluation: 31 general thoracic, 35 adult cardiac and 24 congenital codes. All but two of these codes were accepted by the RUC for review.
To support its claim that procedures require more work than is reflected in the HCFA work values currently assigned to them, STS conducted a survey based on the RUC standard survey tool provided to all specialties. The surveys were obtained from a July fly-in meeting in Chicago, participation at the June STS Coding Workshop, and mailed responses. STS collected a total of 23 full surveys and 75 mini-surveys from its members.
At an August RUC workgroup, STS representatives Dr. John Mayer and Dr. Sid Levitsky presented the survey results and additional data from the STS National Database regarding the changing cardiac patient population in the past five years. The workgroup agreed to the STS recommended increased values for 20 adult cardiac codes and 18 congenital codes. The entire RUC then agreed to these increases at an October meeting. In addition, two adult cardiac codes were sent to the CPT editorial panel for review. However, the STS recommendations for general thoracic codes met with greater resistance from RUC workgroup members, who felt that additional data were needed to support STS claim that these procedures had increased work. Despite this resistance, the RUC agreed to allow STS to extract from its list of submitted codes three high-volume thoracic procedures that would be reconsidered by the RUC at the October meeting.
In response to the RUC workgroups assertion of lack of compelling evidence, STS formed a committee of general thoracic surgeons to develop the arguments. STS members Drs. Sid Levitsky, Mark Orringer, Peter Pairolero, Mark Ferguson, Doug Mathisen, Keith Naunheim, Alex Little, Doug Wood, Joe Putnam, and Keith Horvath, and Charles Shoemaker of the American Society of General Surgeons prepared a strong case that the current values for selected general thoracic surgery codes are undervalued due to a significant change in work and problems the specialty has experienced obtaining accurate work values since the creation of the physician fee schedule. The committee presented its case before the RUC during the October meeting. Upon recommendation of a RUC facilitation committee that was formed to review the codes and data provided by STS, the RUC accepted the STS recommended value for the three selected high-volume thoracic procedures.
The RUC also agreed to allow STS to present nine additional general thoracic codes to the RUC in February 2001 for revaluation. STS will be conducting complete surveys of members on pre-, intra-, and post-service work, in order to correct for any rank order anomalies that would occur as a result of the increased work values assigned to the three approved codes. The survey data is critical: without complete and accurate survey data, the arguments that STS can make are limited!
The RUC will forward its recommendations to HCFA. Although
RUCs decisions are not automatically incorporated into the
physician fee schedule, HCFA has historically relied heavily upon
RUC recommendations when establishing interim work values. The
RUC recommendations will be reviewed by HCFA for inclusion in
the 2002 fee schedule.