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Invited Commentary
April 15, 2020

Global Miscalculations—Relative Value Units and the Value of a Surgeon’s Care

Author Affiliations
  • 1Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor
  • 2Department of Surgery, Brigham and Women’s Hospital, Boston, Massachusetts
  • 3Department of Surgery, University of Michigan, Ann Arbor
JAMA Surg. Published online April 15, 2020. doi:10.1001/jamasurg.2020.0423

The most powerful force in physician reimbursement is one of the least understood. Three times a year, the American Medical Association’s Relative Value Scale Update Committee (RUC) quietly determines how many relative value units (RVUs) are attributed to every service that physicians can bill for. These RVUs determine what Medicare pays physicians for each Comprehensive Procedural Terminology code. To determine the value of each code, a survey asks practicing physicians to estimate how much work goes into each. These survey results are in turn discussed by the RUC members, who—it is worth mentioning—belong disproportionately to procedural specialties rather than primary care. Medicare accepts the RUC’s valuations nearly 90% of the time.1

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