Dear Secretary Price and Administrator Verma:
On behalf of the 21 undersigned medical organizations, we are writing to express our deep
concerns with the new methodology for updating malpractice (MP) relative value units (RVUs)
as discussed in the calendar year (CY) 2018 Medicare Physician Fee Schedule (PFS) proposed
rule. The process used by the Centers for Medicare & Medicaid Services’ (CMS) contractor,
Acumen, to collect MP premium data is neither transparent nor precise and the proposed MP
RVU updates will unfairly reduce payments for providers who regularly furnish surgical
services. We strongly urge CMS to suspend utilization of the new MP premium data for
purposes of calculating MP RVUs as proposed in the CY 2018 PFS. This will allow time
for the Agency and Acumen to collect accurate and complete data for calculating MP
RVUs.
BACKGROUND
RVU Assignment and Updates
CMS pays providers for their services according to the PFS, under which payments are
determined based on the RVUs assigned to each service. Section 1848(c) of the Social Security
Act requires CMS to create RVUs using the Medicare resource-based relative value scale. RVUs
have three components: physician work; practice expense (PE); and MP insurance. Higher RVU
levels indicate that a specific service requires more resources than services with lower RVUs.
MP RVUs, which reflect the relative cost of MP insurance to physician and non-physician
provider (NPP) specialties, are updated annually using a Medicare claims-based specialty mix
for each service. MP premium data are utilized in the MP RVU calculation; CMS generally
updates the MP premium data every five years. The most recent update occurred in CY 2015,
and the next MP RVU update must take place no later than CY 2020, per statute.
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