Who Is On the RUC?
For the last year, I have been working to reconstruct the membership of the RUC, which is probably the most important policy entity in healthcare you've never heard of. The short of it is that RUC is a private organization with a critical public function: it advises the Centers for Medicare and Medicaid Services on how to set the relative prices for physician reimbursement within Medicare.
For example, it's the RUC's job to decide that, say, one treatment of a heart attack is equivalent in value to two treatments of pneumonia. It has come under extensive criticism -- see here, here, and here -- for basically being an unaccountable shadow government that acts in the interest of the American Medical Association and specialist doctors, rather than the medical community as a whole, patients, or the taxpayer. To be clear, I am repeating, not endorsing, that phrasing of the critique of RUC.
Initially, it was my intention, working with Judd Cramer, a friend and grad student at Princeton interested in labor economics, to try to link changes in the composition of the RUC to changes in Medicare's relative prices, known in health-policy circles as RVUs. But we never finished the project, mostly because I was overwhelmed with work this year -- I took a more-than-full load of classes and also wrote this research paper as independent work on the side.
Then the plan was to publish the list in an article with extensive commentary and discussion. In particular, I was very interested in potential conflicts of interest among RUC members, as prior work by Roy Poses has shown this to be a real problem. Yet, to do that, I really needed a complete and fully accurate membership list. That, as I have learned over the last few months, is basically impossible. RUC has been overseen by the AMA since 1991. It now has 32 seats, though it has expanded over the years. This means there are 736 person-years to account for. I could get all but 23 of them.
Over the last year, however, various health-policy researchers have found out that I have been working on this project -- and so I have an increasingly long list of people whom I've been telling to wait.
Yet I've decided that it's in the public interest for me just to publish the list already. (It's the document at the top of this post.) I do so with two honest caveats. First, it's incomplete. I'm missing a handful of years for certain seats, as my efforts to track down some person-years failed. Second, there are probably some inaccuracies. I do not think it is ridden with errors, but I would frankly be surprised if I got everything right. That's just the nature of trying to research a body that has made an extraordinary effort to remain cloaked in secrecy. (The type of error that I think is most likely is that I got some of the years wrong. I think all the names are correct; I am pretty sure anyone I claim was on RUC was in fact on RUC, for approximately the period I say they were. My guess is that I will be off by a year, say, for 10 percent of the people.)
Here is how I put this list together: dozens of hours of archival research. First, I managed to track down old AMA Board of Trustees reports. Those sometimes contained RUC appointments. Second, the medical-specialty newspapers and journals often mention who is currently serving on the RUC on the specialty's behalf. Third, the résumés and websites of ex-RUC doctors often list their full years of service; sometimes you can also find these in articles for the medical-specialty publications when they retire. Fourth, the AMA recently began publishing the current membership as part of an (admirable, but highly incomplete) effort towards transparency. Fifth, I relied on other efforts that Roy Poses and Brian Klepper, among others, have made, to identify RUC members.
I will also try to release some of the related research that I have done on RUC in the coming days. It was past time for me, however, to share this document. Thank you to the many who helped or cheered along this project.