Results, Potential Effects, and Implementation Issues of the Resource-Based Relative Value Scale
- William C. Hsiao, PhD;
- Peter Braun, MD;
- Nancy L. Kelly, ScD;
- Edmund R. Becker, PhD
Abstract
This article presents the overall results of the Resource-Based Relative Value Scale (RBRVS) study. We present resource-based relative values for selected services in each of the 18 specialties we studied. We found that preservice and postservice work represents close to 50% of total work for invasive services and 33% of total work for evaluation/management services. We also found that the work per unit time (a measure of intensity) for invasive services is about three times that of evaluation/management. We developed a simple model and simulated an RBRVS-based fee schedule for the Medicare program under a "budget-neutral" assumption. Results for 30 commonly performed services show that office visit fees for evaluation/management services could rise by 70%, while some surgical fees could drop by 60%. We also simulated what the Medicare outlays would have been in 1986 for categories of medical services under an RBRVS-based fee schedule. We found that total Medicare payments for evaluation/management services would have increased by about 56%. Invasive, imaging, and laboratory services would have decreased by 42%, 30%, and 5%, respectively. We also discuss implementation issues related to an RBRVS-based fee schedule, such as the determination of a monetary conversion factor, practice costs, billing codes, and the need to evaluate the potential impacts of an RBRVS-based payment system on the cost and quality of health care.
(JAMA 1988;260:2429-2438)
Footnotes
-
The opinions expressed herein are those of the authors and do not necessarily reflect the views of the Health Care Financing Administration.
-
Reprint requests to the Physician Payment—Relative Value Study, Harvard University School of Public Health, 677 Huntington Ave, Kresge, Third Floor, Boston, MA 02115 (Dr Hsiao).
