Cross-specialty linkage of resource-based relative value scales. Linking specialties by services and procedures of equal work
P. Braun, D. B. Yntema, D. Dunn, M. DeNicola, T. Ketcham, D. Verrilli and W. C. Hsiao
Department of Health Policy and Management, Harvard University School of Public Health, Boston, MA 02115.
This article describes methods used to combine into a common scale
resource-based relative values from separate specialties. The key to
producing a common scale is identifying pairs ("links") of services from
different specialties that require approximately equal amounts of
intraservice work. We distinguished two kinds of pairs of link services,
those judged to be the same and those judged to be equivalent, usually
within a narrow category of medical activity. Working with a
cross-specialty panel of physicians and with data on time factors from a
national survey, we selected sufficient links to connect each specialty to
others by at least four links. We then used the weighted least-squares
method to locate all the links optimally on a single, common scale.
Analyses of the accuracy of this scale showed that the typical disagreement
between specialties about where to locate the intraservice work of a given
service was only 7%. Other analyses showed that the accuracy of the common
scale was not sensitive to different classes of links.
