So, good morning, everybody, and thanks for being here. I've been tasked to talk about this really, really big topic that I'm going to wrap up in a short period of time. So if you look at the factors that affect patient access, there are multiple. But two of the factors that have really taken away access from patients are directly related to the fact that physician reimbursements have kind of not gone anywhere. In fact, they have reduced over time. And you're all familiar with this AMA slide where we see that there's a 22% reduction in our reimbursement over the last 20, 21 years. And the update this year was not very encouraging either. We got a 2% cut, which we should say we are happy about was not 4.5% as they initially proposed, thanks to advocacy through SC&I and multiple other societies. So what is RUC? When I first started, I didn't know what RUC was. So RUC is a Relative Value of Scale Update Committee. And it is composed of 32 physicians who volunteer their time. And they form a committee that advises CMS on how to reimburse a member or the physicians for the work they do. And historically, CMS has accepted about 90% of RUC recommendations. And as we all know, whatever recommendation CMS makes eventually affects all aspects of our payment. And the AMA-sponsored RUC process, it has its own negative aspects. But good or bad, it is currently the only platform where we can have a voice and participate in valuing our own services. So it makes it a very powerful platform. And as it was said earlier in the talk, SC&I does have a very active voice in RUC at this point. We have CPT and RUC workgroups, which are constantly working to identify areas of work that we are doing that is undervalued or not valued and develop strategies to help get ourselves reimbursed for it. But this is not a very simple process. It is time-consuming, effort-consuming, and it requires member participation. And the members are us, we interventional cardiologists. We need to provide RUC with the data that is necessary for them to determine what the RVU value for the piece of work that you're doing is or the service you're providing is. They need the data regarding intensity, complexity, effort, and the time required. And keep in mind, these 32 physicians who are making this decision are not interventional cardiologists. Most of them are from primary care specialties, your family physicians, internal medicine, OB-GYN. They've never stepped into a cath lab. They don't know what you do. They don't know how hard it is what you do, but they are determining what the value is going to be based on the information you give them. So that data is key. And the way we gather this data from the members is through the RUC surveys. And these are randomly sent out by SCI. They come as an AMA survey. And filling out these surveys in a very meticulous fashion is important because to maximize the impact that we have at the RUC committee, we need as many responses as possible. So if you go to a RUC committee saying only 20 people responded and we sent out 1,000 surveys, where it's just like going and saying, oh, we had 300 people respond, the people who are making the decision evaluating that data are more likely to give it more respect if more people are responding. And also the responses need to be honest. This is not your opportunity to brag. This is your opportunity to truly communicate to another physician who does not practice your specialty, what is the complexity involved in what you do? And these are not surveys that you can just do on the fly. So if you are chosen to do a survey, don't try to do it when you are going up the elevator from one patient to another or walking and talking with somebody. These are surveys you really need to set aside some time. And from personal experience and talking to other people, they take about 25 to 40 minutes to complete these surveys. And these surveys, the responses you give, be very meticulous and thoughtful because they are going to determine how much you're going to be reimbursed for the service or the CPT code that they are surveying you for. So Sky is building a robust machinery to utilize the RUC process so that we can advocate for our reimbursement. We are trying to gather as much good data as possible when we go to the RUC committee to ask for, this is what we believe we need to be reimbursed. And we have had some good successes. In the last one year, we have gotten a RUC to value congenital mammography codes, the intravascular lithotripsy codes. And just to give you an idea of how tedious hard this process is, the congenital mammography codes took a good four to five years. And it's going to be another one year before we can actually utilize them. So it is time consuming. And the more data RUC has, well-organized data RUC has, the more likely this process will go smoothly and faster. And RUC constantly keeps reviewing these codes. So say you did a survey a year ago. And two years later, you get back the same survey. Don't say, hey, I did the survey two years ago. Why do it now? The reason you have to do it again is if it goes back to RUC and it comes across like this procedure or this service is not as hard, it's gotten easier over the last two years, they're just going to knock your reimbursement. And because they are just comparing work and effort and whether the RBUs you're receiving is commensurate to that. And if your survey does not reflect that, you're not going to get compensated for it. So historically, as I said, CMS has accepted 90% of RUC recommendations. But off late, it's giving a little bit of pushback. So the recommendation acceptance is about 75%. So Sky, as a society, we are trying to advocate for our members beyond RUC, as Andrew went over through our grassroots campaigns. And our Skypack has played a big role. And I just wanted to quickly go over where our Skypack stands today. From three years ago, when we were practically nothing, we have come up to $73,000, and this is great. But if you compare it to the vascular surgeons or the interventional radiologists, we are not there yet. And if you're thinking why your vascular surgeon or interventional radiology colleague is getting reimbursed a little better than you for the same work, then it's the power of lobbying. So I request that you all support the Skypack if you already have been supporting. Thank you so very much. So at the end of this talk, if I want you to take a couple points home, they would be these. One, if you are selected randomly to complete a RUC survey, please take the time. Please be honest about your answers. Keep in mind, you have to communicate how hard your work is in terms of the complexity, in terms of the effort involved, in terms of the time involved. In a way that the person who has never done this should feel how hard this is to determine your reimbursement. As in any other finances, time is money, time is money. So make sure that you complete these surveys in a very meticulous, well-thought-out fashion. And it's not about how you alone do it. It's a question of how this is, in general, done by an average cardiologist. Think of somebody who doesn't have an APP support, doesn't have resident, doesn't have fellows, and what's the effort going in before, during, or after the service? So when you answer responses, it's not about how quick you are, how fast you are, or how many you can do in a go. It's about what's involved for doing that one procedure if you truly look at it as you doing it as a whole. And if you are not selected, please encourage your friends and your acquaintances, and even people you don't like, go ahead and tell them about the RUC, and tell them how important it is to do these surveys diligently because this is what determines your reimbursement. And then, last but not the least, please support the Sky Pack. Right now at Sky Central, they are renewing the memberships. They're giving you a $100 discount. And then what you can do is to complete your 10,000 steps, just walk over a little more to the Sky Pack and do the small donations. There's a lot of power in small donations. So with that, thank you so very much. Thank you. Thank you.

patient access to healthcare

physician reimbursements

reduction in reimbursements

Relative Value of Scale Update Committee (RUC)

physician participation in RUC surveys