During the COVID-19 pandemic, governments changed rules and procedures related to Medicaid enrollment. These changes…
Shannon Butkus ‘18 is one of 32 health professional volunteers that will help set Medicare reimbursement rates
Shannon Butkus ’18, PhD, a Texas A&M University School of Public Health adjunct faculty member, former student and licensed speech pathologist, has been selected to serve on the American Medical Association (AMA) RVS Update Committee (RUC) Health Care Professionals Advisory Committee (HCPAC). This volunteer group comprised of 32 physicians and other health care professionals provides input into proposed reimbursement rates for medical procedures that are ultimately set by the Centers for Medicare & Medicaid Services (CMS).
The RUC’s involvement is part of a process designed to identify a fair and equitable reimbursement rate for various medical procedures. “Most providers appreciate that they get reimbursed, but they don’t realize the making of the procedure code,” Butkus said. “Every specialty society has advocates within their profession who are sitting down with the AMA and CMS to say, ‘The services we do are meaningful, and they have value. We want to make sure that they are fairly represented.’”
An inclusive process
The creation of a CMS-approved procedure code involves several steps. “Every procedure code moves along a journey,” Butkus explained. “It starts with a society or an industry organization saying, ‘We believe there’s a need for a procedure code to support some particular procedure, piece of equipment or service.’”
Medical societies then submit applications for recommended procedure codes to the American Medical Association’s Current Procedural Terminology (CPT) Editorial Board for review. If the board agrees on the need, the code is then sent to the AMA RUC for input.
Butkus serves on the AMA RUC’s Health Care Professionals Advisory Committee (HCPAC), which reviews rates for procedures by ancillary service providers. Butkus became eligible to serve in this capacity through participating on the American Speech Language Hearing Association (ASHA) Health Care Economics Committee for six years. Based on this work, ASHA’s leadership recommended Butkus for the RUC position, which began in January 2023.
HCPAC’s role involves recommending the relative value of each procedure code, taking into account professional inputs and actual supplies and equipment needed to perform the procedure. “As CMS is setting the Medicare physician fee schedule, they review procedure codes as well as the recommended values,” Butkus said, adding that CMS also considers congressional input in its deliberations. “Annually, CMS updates the code list to account for changes in Medicare coverage and payment policies. It’s a great opportunity to help inform reimbursement for services, not only in my field, but across specialties.”
The business of health care
Butkus noted that serving on the RUC involves delving into the business side of health care, an area in which many health care professionals are less knowledgeable.
“Health care professionals want to practice medicine. We want to make a difference for the people we’re working with, whether Medicare recipients, adults or children,” she said. “There’s a significant focus on clinical training in our programs to prepare us to meet the needs of our patients. Because of that, most advanced degree programs don’t have an opportunity to teach the business of our profession.”
Butkus has seen this paradigm firsthand. She earned her undergraduate degree and master’s degree from Baylor University and worked as a clinical speech pathologist for approximately 20 years. She owned her own practice and began doing regulatory advocacy work, which offered opportunities to engage with health insurers.
After marrying David Riggs ‘99, a senior computer specialist with the Texas A&M Foundation, Butkus decided she wanted to become an Aggie and considered earning a second master’s degree. “At that point, I was relatively seasoned in my career, so every department said, ‘Oh, that’s great. We would love to have you, but you probably should go the PhD route,’” she recounted.
The couple didn’t have children at the time, so Butkus had no hesitancy in enrolling in one of the School of Public Health’s doctoral program. “I was very passionate about clinical practice and knew some about the business aspects of health care, but I felt compelled to complete a PhD because I needed to better understand the insurance perspective,” she said.
Butkus’ and Riggs’ lives soon changed when the couple adopted a son at the end of Butkus’s second year in the doctoral program. Just as Butkus started writing her dissertation, they also started fostering a young girl with special needs—and eventually adopted her shortly after graduation.
Butkus managed to complete her dissertation while caring for the two young children and graduated with a doctoral degree in health services research with a concentration in healthcare economics. She immediately was hired by UnitedHealth Group as vice president for skilled therapies and has since been promoted to vice president for utilization management strategy and clinical implementations.
The College Station, Texas, resident also works as an adjunct faculty member for School of Public Health’s Executive Masters in Health Administration (EMHA) degree program, where she teaches a human resource course for health care professionals.
“I teach the theoretical because concepts matter, but I also relate it back to everyday experiences the students will encounter as health care leaders. We start by walking through the steps needed to build the business case to hire a new person onto a team, then take students through the recruiting and interviewing process, and ultimately end with performance management and compensation activities,” she said. “I’ve tried really hard to think about the skills our EMHA students—who are likely going out into business-related mid-management and executive roles in hospital systems and ancillary systems—need to be successful as they advance throughout their careers.”
In addition, Butkus and Riggs have committed to supporting future Aggies through creating several scholarships. “We’re very passionate about education and paving a pathway for students to have opportunities to pursue education,” Butkus said, adding that one of the couple’s scholarships honors the experience of their daughter, who is a minority. “We have a Texas A&M Foundation scholarship that supports an African American student in the School of Public Health.”
A worthwhile academic effort
Ultimately, Butkus credits the school’s doctoral program for opening doors that she wouldn’t have been able to access otherwise. “Adding PhD after my name added the credentials that were needed for legislators and senior leaders at insurance companies to say, ‘Hey, this person really does have the level of expertise and the recognition that we need,’” she said.
She also believes her academic studies combined with her other life experiences prepared her to step into her role at United, which includes chairing a disability inclusion group. “I get to infuse my knowledge as a provider and my experiences as a caregiver in navigating my insurance company for my daughter’s care to really center clinical conversations. I often ask questions like ‘How are the things we’re doing working? How are they impacting our providers and members? And how can we make decisions in ways that are provider-centric and member-centric?’” she said. “In small ways, I help strip some of the complexity out of health insurance to create better and simple experiences.”
Her studies also helped her find a niche that she is passionate about—and she has found that her concentration in healthcare economics allows her to meaningfully contribute to conversations around health care numbers. “I love understanding how the codes come together to make the code book that our providers use,” she said. “It’s not the sexy stuff, but it’s really the important stuff because it’s the foundation upon which providers get paid.”
Media contact: Dee Dee Grays, email@example.com, 979.436.0611