Michael Bishop, MD, FACEP, an emergency physician at Indiana University Health Bloomington Hospital and former member of the ACEP Board of Directors, has been named Vice Chair of the American Medical Association (AMA)/Specialty Society Relative Value Scale Update Committee (RUC).

An emergency physician for more than 40 years, Dr. Bishop is the specialty’s first to be RUC Vice Chair.

The RUC provides the Centers for Medicare & Medicaid Services (CMS) with annual recommendations used to determine the value of work performed by physicians across specialties. Twenty-one of its 31 members are appointed by societies like ACEP, and the remaining seats are held by leadership and rotating positions.

Dr. Bishop, who has served since 2002 as the ACEP representative on the RUC, was nominated by ACEP and the Indiana State Medical Association and appointed this year by the AMA Board of Trustees to represent the AMA, which brings the title of Vice Chair.
Jennifer Wiler, MD, MBA, FACEP, an emergency physician based in Colorado, will take his seat as ACEP representative and continue to ensure emergency medicine has a place at the table.

While it does not deal with reimbursement or fee schedules, each year the RUC evaluates the relative worth of the services physicians perform and makes recommendations to CMS based on surveys of practicing physicians. CMS can decide whether to accept the recommendations and then determines the monetary value and a geographical conversion factor to assign to each service.

“What is an appendectomy worth compared to a heart transplant compared to an office visit compared to a chest X-ray?” Dr. Bishop offered as an example of the decisions the RUC makes. CMS can also ask the RUC to evaluate CPT codes it thinks may be misvalued and to determine values for new codes.

Prior to the early 1990s, Medicare fee schedules were based on the charges of individual physicians from two years prior, Dr. Bishop said. “It really wasn’t based on much or even quasi-scientific,” he said. “Everyone was paid at different levels.” Now, though the RUC has no power to make decisions, CMS can turn to the very people who do the work to get the best information available.

“Who else is going to come along and say, ‘Let me explain this heart surgery procedure to you’?” said Dr. Bishop. “We feel it has to be done by physicians. Sometimes it takes a long time to figure out what they’re doing, and an economist or accountant wouldn’t have any way to really come up with a valid value.”