“The ACR is better served when its members are also members of the AMA. The more AMA members we have, the more voices radiology has throughout the house of medicine,” says Ezequiel “Zeke” Silva III, MD, FACR, FSIR, FRBMA, RCC. In March, Silva assumed the role of chair of the AMA’s Multispecialty Relative Value Scale Update Committee (RUC). Silva, who is immediate past chair of the ACR’s Commission on Economics and Harvey L. Neiman Health Policy Institute® founding board member, is the first radiologist appointed to chair the RUC.
Nearly three decades ago, the AMA created the RUC to address the transition to a Medicare physician payment system based on the resource-based relative value scale (RBRVS). The RUC is a multispecialty committee of roughly 30 members (mostly physicians) tasked with communicating the resources required to provide physician services — which CMS considers in developing relative value units (RVUs). The RUC’s relative value recommendations to CMS drive the values assigned to new or revised Current Procedural Technology (CPT®) codes. There are approximately 10,000 CPT procedure codes, and the RBRVS is updated annually to reflect new and revised codes. The RUC, in essence, gives medical professionals a voice in shaping relative values for Medicare procedures — but CMS makes all final decisions about what Medicare payments will be.1
Silva recently told the Bulletin what it means to serve as RUC Chair, why the clinical expertise of its members is so important, and how growing more radiology leadership roles will move the needle on innovations that ensure quality patient care.
How significant is it that a radiologist now chairs the RUC?
I am extremely proud to have been nominated and appointed to this role. It is a credit to the respect the ACR and all of radiology have within the broader house of medicine — which I see as a broader credit to the quality of the ACR and the quality of radiology in general. The ACR has had a permanent seat on the RUC since its inception and we have been important contributors to the RUC and its commitment to quality patient care. When you look at the challenges collectively facing medicine, it is significant that a radiologist was selected to lead that effort.
How does the ACR fit into the RUC process?
The ACR is visible in all parts of the RUC. The members of the RUC are part of a multispecialty group and each sit in their own specialty seat. However, each RUC member functions independent of their specialty. In fact, RUC members may not advocate on behalf of their specialty at any time. That means when RUC members vote on a procedure performed by their specialty, they are not voting on behalf of their specialty, but as an independent participant.
ACR also has an advisor and an alternate advisor serving on the RUC’s Advisory Committee and Specialty Society Committees. Anytime a radiology code is valued, the ACR RUC advisor prepares recommendations for the RUC — which are discussed and potentially modified before the RUC presents its final recommendation to CMS. The ACR RUC advisor works with an expert panel, often including clinical experts in the procedure at hand. This group prepares and submits recommendations that are clinically appropriate and clinically credible. Because independent RUC members are not radiologists, they often pose specific questions about the procedure and valuation recommendation. The ACR advisors interpret survey data randomly gathered from ACR members to inform their recommendation to the RUC. The Relativity Assessment Workgroup is a subcommittee of the RUC, which identifies potentially misvalued services. For example, CT of the abdomen and pelvis has been revisited several times, as well as multiple IR procedures.
Are there areas of the RUC’s work you would like to build upon?
My main goal as chair is to facilitate the RUC effectively doing what it has always done. That is, bring clinical expertise to the valuation process in a way that ensures patients receive the best possible care from their physicians. An important strength of the RUC is its ability to help integrate healthcare innovation into physician payment system. A great example within radiology is innovative imaging techniques, IR, nuclear medicine, and radiation oncology. There is also a lot happening with telehealth, augmented intelligence, and digital therapeutics — to name a few areas for reimagining care. For instance, the COVID-19 public health emergency has brought telemedicine, including teleradiology, to the forefront of care and we want to make sure these types of services continue to have a place in Medicare and in medicine in general. I also want to ensure the clinical expertise the RUC brings to shaping policy stays at the highest standard. CMS and other policymakers have always given a nod to our expertise — how it fairly and appropriately informs valuation for patient services.
"Dr. Silva’s outstanding collaborative work and contributions in the fields of medicine and healthcare economics have earned the respect and trust of physicians and allied professionals across the house of medicine. I can’t think of a better choice to lead the AMA Multispecialty Relative Value Scale Update Committee into the future."
How does clinical expertise drive future policy?
A perfect example from a few years back is fetal MRI. It is a very complex procedure, and we are fortunate in our specialty to have radiologists who have dedicated significant parts of their academic and professional careers to taking care of this population of patients. When only a select group of radiologists perform this study, you have to assume when you walk into the RUC that members from other specialties will not understand the procedure and its importance. I firmly believe that the clinical expertise within the RUC is what makes it possible for patients to receive the most effective, up-to-date care available because their doctors have the resources to provide it. The fact that a group of radiologists are contributing to and helping shape healthcare policy through this process is perfectly indicative of what the ACR does to empower its members.
Why is AMA membership important for ACR members?
The number of delegates we have in the AMA House of Delegates (HOD) is directly proportional to the number of individual ACR members who are also members of the AMA. Delegates vote on policy, and some of that policy directly affects radiology. The HOD includes representatives from state medical associations, national medical specialty organizations, professional interest medical groups, and federal services. The ACR currently has eight delegates, and that number is expected to grow. We have a strong radiology specialty caucus within the AMA, and ACR’s delegation is the largest. It is vital to enable more radiologists to contribute as thought leaders — this is one way to accomplish that.
What lies ahead for the RUC under your leadership?
Our credibility as a specialty continues to grow as radiologists assume more national leadership positions. The ACR has always done a very good job at looking beyond existing policy and payment systems to explore what is coming next. I oversaw the College’s economics team for a long time and would always stress the importance of pondering future trends. At the same time, I was always thinking about next opportunities for the ACR — how to allocate resources appropriately and advance the best interests of the specialty. Even though I am now leading an independent group like the RUC, I remain as confident as ever in the ACR and its future role. My goals as RUC chair mirror what the ACR has always embodied — innovation and quality patient care.