"Unintended Consequences of Resource-based Relative Value Scale
Reimbursement." Journal of the American Medical Association 298 (19): 2308-10.
Resource-Based Relative Value Scale
(RBRVS): A useful tool for practice analysis.
For the sake of simplicity, no mention was made of diagnosis-related groups (DRG) for hospitals or the Medicare resource-based relative value scale
or other physician payout systems.
The system pays claims for the clinic plans based on the American Society of Anesthesiologists, Discount of Charge, Resource Based Relative Value Scale
, and Medicare fee schedules.
Likewise, for physician services, differences in resource use could lead to separate relative value scales
by payer, or separate conversion factors applied to a single relative value scale
, depending on how differences in resource use by payer vary across CPT codes.
Policy alternatives such as prospective payment, DRGs, and resource based relative value scale
payments are evaluated.
Regulating Doctors' Fees: Competition, Benefits, and Controls under Medicare is a timely compilation of articles, commentaries and discussions that examine William Hsiao's proposal for Medicare to use his Resource-based Relative Value Scale
(RBRVS) as a cornerstone for physician payments.
Under that approach, providers would be required to accept hospital DRG rates or physician relative value scale
fees if they are adopted by private carriers.
These rates would be based upon existing Medicare methodologies, such as the diagnosis-related group (DRG) methodology for hospitals and the resource-based relative value scale
(RB RVS) for physicians.
In 2014, an estimated $87 billion was paid for services furnished to Medicare beneficiaries by physicians and other practitioners using the resource-based relative value scale
(RBRVS) (Centers for Medicare & Medicaid Services [CMS] 2014).
Medicare sets prices periodically through a convoluted bureaucratic process that involves secret meetings by a select AMA committee, the AMA/Specialty Society Relative Value Scale
Update Committee or "RUC."
And, the authors said, blame for the discrepancy can be squarely placed on the American Medical Association's Relative Value Scale
Update Committee (RUC) and Medicare, based on their review of a common evaluation and management code as well as two common procedural codes.