WASHINGTON -- A group of primary care physicians is suing the federal government, claiming its heavy reliance on an American Medical Association (AMA) panel for guidance on payment rates under Medicare's relative value scale is illegal.

The lawsuit, filed Monday in U.S. District Court in Maryland, alleges that such reliance by the Department of Health and Human Services (HHS) and the Centers for Medicare and Medicaid Services (CMS) results in payment rates that undervalue the services of primary care doctors.

The AMA's Specialty Society Relative Value Scale Update Committee, known as the RUC, is a 29-member panel responsible for determining the relative value of specific medical services and making recommendations to CMS, which uses the recommendations to set the Physician Fee Schedule that determines how much doctors are paid for treating Medicare patients.

Paul Fischer, MD, an FP in Augusta, Ga., and one of the six physician plaintiffs, told MedPage Today that the undervaluing of primary care services has led to a huge pay discrepancy between primary care doctors and specialists, as well as a drop in the number of medical students who pursue primary care careers.

The suit charges that CMS has followed the panel's recommendations more than 90% of the time since the panel's creation in 1991, but, they argue, the group isn't an official federal advisory committee. Hence, such near-total reliance is illegal.

The RUC operates mostly behind closed doors, the plaintiffs charge, and meeting attendees and panel members -- nearly all of whom are specialists -- must sign agreements not to discuss meeting deliberations.

The suit also alleges that the public, as well as the plaintiffs -- who all work with Fischer at the Center for Primary Care in Augusta -- has been harmed by the government's reliance on the RUC.

Specifically, the lawsuit says that the undervaluing of services provided by primary care physicians has led to "a scarcity of new doctor candidates for hire, limited openings for new patients, a decreasing ability to serve the needs of existing Medicare and Medicaid patients, increasingly shortened patient visits, increasingly complex diagnoses within these shortened visits, and an inability to serve the needs of the 30 million newly established Medicaid patients under ACA as a result of Defendants' actions."

Under the Affordable Care Act (ACA), Medicaid rates will mirror Medicare rates in 2013 and 2014.

The doctors are seeking to change the way medical services are valued under Medicare (and by extension, Medicaid) but are not seeking any damages. Among other things, they want the RUC declared a federal advisory committee, and its meetings opened to the public.

According to the doctors, the relationship between the RUC and CMS "creates systemic incentives to provide unnecessary and unnecessarily complex services. It is not unreasonable to argue that this single relationship is the core driver of runaway healthcare costs, threatening the stability of American healthcare economy and the larger U.S. economy," they wrote on the website www.saveprimarycare.org, which is collecting donations for the lawsuit.

Of the 29 members on the RUC, three represent primary care specialties. Most are appointed as representatives of various other specialty groups.

When asked for a comment on the lawsuit, RUC chair Barbara Levy, MD, said primary care doctors are represented on the panel.

"The RUC is an independent panel of physicians from all medical specialties, including primary care, who make recommendations to CMS as all citizens have a right to do," she said in an emailed statement. "These volunteers provide physicians' voice and expertise to Medicare decision-makers through their recommendations."

Rep. Jim McDermott, MD, (D-Wash.) voiced his support of the doctors suing CMS.

"CMS must do its rate-setting job in the public interest and not in the interest of powerful physician specialties – more transparency and fairness would be good for the health of Americans as well as our federal budget," McDermott said in a press release. "It is for this reason that I support all efforts – whether legislative or judicial – to restore fairness in physician payments and re-balance the physician workforce in the United States."

McDermott, a psychiatrist, is the sponsor of a bill that would add public data from independent analysts to compare to the RUC's recommendations; the independent analysts also would identify services that may be over- or under-valued.

"For two decades now, this panel has been dominated by specialists who undervalue the essential and complex work of primary care providers and cognitive specialists, while often favoring unnecessarily complex, costly and excessive specialty medical services," said McDermott in a statement posted on his website in March.

His bill is endorsed by the American Academy of Family Physicians, which opposes the current set-up of the RUC and has called for more seats on the panel for family medicine, general internal medicine, and general pediatrics, as well as for greater transparency in how members vote.

Fischer has been championing the case against the RUC and the need for better representation of the needs of primary care widely, including in publications such as MedPage Today.