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Topics in Practice Management |

The Resource-Based Relative Value Scale and Physician Reimbursement PolicyUpdating Medicare Relative Value Units

Miriam J. Laugesen, PhD
Author and Funding Information

From the Department of Health Policy and Management, Columbia University, New York, NY.

CORRESPONDENCE TO: Miriam J. Laugesen, PhD, Department of Health Policy and Management, Columbia University, 600 W 168th St, Sixth Fl, New York, NY 10032; e-mail: ml3111@columbia.edu


FUNDING/SUPPORT: This work was supported by the Robert Wood Johnson Investigator Award in Health Policy Research Program.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2014;146(5):1413-1419. doi:10.1378/chest.13-2367
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Most physicians are unfamiliar with the details of the Resource-Based Relative Value Scale (RBRVS) and how changes in the RBRVS influence Medicare and private reimbursement rates. Physicians in a wide variety of settings may benefit from understanding the RBRVS, including physicians who are employees, because many organizations use relative value units as productivity measures. Despite the complexity of the RBRVS, its logic and ideal are simple: In theory, the resource usage (comprising physician work, practice expense, and liability insurance premium costs) for one service is relative to the resource usage of all others. Ensuring relativity when new services are introduced or existing services are changed is, therefore, critical. Since the inception of the RBRVS, the American Medical Association’s Relative Value Scale Update Committee (RUC) has made recommendations to the Centers for Medicare & Medicaid Services on changes to relative value units. The RUC’s core focus is to develop estimates of physician work, but work estimates also partly determine practice expense payments. Critics have attributed various health-care system problems, including declining and growing gaps between primary care and specialist incomes, to the RUC’s role in the RBRVS update process. There are persistent concerns regarding the quality of data used in the process and the potential for services to be overvalued. The Affordable Care Act addresses some of these concerns by increasing payments to primary care physicians, requiring reevaluation of the data underlying work relative value units, and reviewing misvalued codes.

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