1. Relative Value System Update Committee (RUC) AMDA Efforts Charles Crecelius MD PhD FACP CMD

2. Relative Value System Update Committee RBRVS – –Resource Based Relative Value Scale –Relative value of medical services –RVU = relative value unit RUC – Committee that suggests RVU to CMS –29 voting members, 114 Advisory Committee members Utilized by Medicare and also other payors RVU determined by survey process of time and intensity of work, presented and voted on by RUC NH codes surveyed & presented by AMDA

3. 2008 $$ Reimbursement CodeNursing Home OfficeHospitalHome Care 99xx119.02 99xx237.0836.1334.9249.77 99xx356.9058.2162.3674.94 99xx475.9987.5989.43109.52 5 99xx5111.34118.57153.46

4. AMDA RUC Involvement More than just getting more money for nursing home work Keeping track of general payment issues Being involved in trends in payment Collaborating and networking with others –Payment, quality issues –Allied issues

5. Medicare Administrative Carriers Will replace Fiscal Intermediaries / Medicare Carrier (as part of MMA) 15 Medicare A/B Jurisdictions 4 DME Jurisdiction 4 Home Health & Hospice Jurisdictions Critical areas: customer service, operational excellence, financial management, consistency, competition Full transition by Oct 2009

6. 1 = Palmetto 3 = Noridian Administrative Services 4 = Trailblazer Health Enterprises 5 = Wisconsin Physician Services 12 = Highmark Medicare Services

7. Jurisdiction States Included in Jurisdiction A Connecticut, Delaware, District of Columbia, Maine, Maryland, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island, and Vermont B Illinois, Indiana, Kentucky, Michigan, Minnesota, Ohio, and Wisconsin C Alabama, Arkansas, Colorado, Florida, Georgia, Louisiana, Mississippi, New Mexico, North Carolina, Oklahoma, Puerto Rico, South Carolina, Tennessee, Texas, U.S. Virgin Islands, Virginia, and West Virginia D Alaska, American Samoa, Arizona, California, Guam, Hawaii, Idaho, Iowa, Kansas, Missouri, Montana, Nebraska, Nevada, North Dakota, Northern Mariana Islands, Oregon, South Dakota, Utah, Washington, and Wyoming DME MAC Jurisdictions

8. Jurisdiction States Included in Jurisdiction A Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island, &Vermont B Colorado, Delaware, District of Columbia, Iowa, Kansas, Maryland, Missouri, Montana, Nebraska, North Dakota, Pennsylvania, South Dakota, Utah, Virginia, West Virginia, & Wyoming C Alabama, Arkansas, Florida, Georgia, Illinois, Indiana, Kentucky, Louisiana, Mississippi, New Mexico, North Carolina, Ohio, Oklahoma, South Carolina, Tennessee, & Texas D Alaska, American Samoa, Arizona, California, Guam, Hawaii, Idaho, Michigan, Minnesota, Nevada, New Jersey, New York, Northern Mariana Islands, Oregon, Puerto Rico, U.S. Virgin Islands, Wisconsin, & Washington Home Health & Hospice MAC Jurisdictions

9. Patient Centered Medical Home Physician coordinated care –Personal physician –Physician directed medical practice –Whole person orientation –Care is coordinated and/or integrated –Quality and safety –Enhanced access to care –Payment to support the PC-MH Supported by technology, systems, EBP Addresses high care / chronic care needs Three tiers of involvement

10. Medical Home Supported by ACP, AAFP, AAP, AOA AMDA’s interest primarily AL RUC being asked to propose payment –Reimbursement: FFS, PPS, P4P –Workgroup will include geriatricians –Rapid deadlines June 2008 for payment proposal January 2009 for actual implementation

11. Collaboration Variety of issues with AGS Closer relationship with ACP, AAFP –Met with AAFP re: role of attending physician in the nursing home –Discussing Nurse Practitioner – Physician scope of practice issues in LTC with AMA, ACP, AAFP –Supported additional primary care seat on RUC (AGS, ACP, AAFP) –Networking with other committee via RUC