Specialty Society Relative Value Scale Update Committee

The Specialty Society Relative Value Scale Update Committee or Relative Value Update Committee (RUC, pronounced "ruck") is a private group of 31 mostly specialist physicians who have made highly influential recommendations on how to value a physician's work when computing health care prices in the United States' public health insurance program Medicare.

Before the 1992 implementation of the Medicare fee schedule, physician payments were made under the "usual, customary and reasonable" payment model (a "charge-based" payment system). Physician services were largely considered to be misvalued under this system, with evaluation and management services being undervalued and procedures overvalued. Third-party payers (public and private health insurance) advocated an improved model to replace the UCR fees, which had been associated with stark examples of specialists making significantly higher sums of money than primary care physicians.

With reference to the research of William Hsiao and colleagues, the Omnibus Budget Reconciliation Act of 1989 was passed with the legislative intent of reducing the payment disparity between primary care and other specialties through use of the resource-based relative value scale (RBRVS). However, RBRVS was never fully implemented, partially due to RUC.

RUC was established in 1991 by the American Medical Association (AMA) and medical specialist groups. The AMA sponsors RUC "both as an exercise of 'its First Amendment rights to petition the Federal Government' and for 'monitoring economic trends ... related to the CPT [Current Procedures and Terminology] development process".

RUC is highly influential because it de facto sets Medicare valuations of physician work relative value units (RVUs) of Current Procedural Terminology (CPT) codes. (The Centers for Medicare and Medicaid Services (CMS) is the de jure work RVU determining body.) On average, physician work RVUs make up slightly more than half of the value in a Medicare payment. Historically, CMS has accepted RUC recommendations more than 90% of the time. Health economist Uwe Reinhardt characterized the CMS as slavishly accepting RUC recommendations. The physician work RVU values accepted by CMS also influence private health insurance reimbursement.

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