0
Correspondence |

The Critical Flaw in Physician Compensation Is Not the Sustainable Growth Rate!The Inequity of Relative Values FREE TO VIEW

James A. L. Mathers, MD, FCCP
Author and Funding Information

From Pulmonary Associates of Richmond, Inc.

CORRESPONDENCE TO: James A. L. Mathers, MD, FCCP, 1000 Boulders Pkwy, Ste 200, Pulmonary Associates of Richmond, Inc, Richmond, VA 23225; e-mail: jamathers@verizon.net


Editor’s Note: Authors are invited to respond to Correspondence that cites their previously published work. Those responses appear after the related letter. In cases where there is no response, the author of the original article declined to respond or did not reply to our invitation.

FINANCIAL/NONFINANCIAL DISCLOSURES: The author has reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

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


Chest. 2015;147(4):e156. doi:10.1378/chest.14-2909
Text Size: A A A
Published online
To the Editor:

While there has been extensive discussion on the effect of the sustainable growth rate formula on physician compensation, the deeply flawed Resource-Based Relative Value Scale (RBRVS) system has received little notice. Two CHEST articles by Laugesen1 (November 2014) and Kumetz and Goodson2 (September 2013) should attract the attention of all who are interested in the complexity and inequity of physician compensation.1,2 Both of these articles touch on the flaws within the system, and one must ask the question of whether accurate relative values can be established between cognitive and procedural interventions.

Inquiry into the origins of the RBRVS reveals that the initial framework was designed to be applied to procedural services; cognitive services were incorporated later in the process. The legislation that established the RBRVS included a requirement that values be reviewed at least every 5 years. As this legislation was evolving, the American Medical Association quickly established the Relative Value Scale Update Committee (RUC) with a membership heavily tilted toward procedural specialties. Centers for Medicare & Medicaid Services turned to that committee to meet the statutory requirement for review. Responsibility for reviewing final valuations was given to the Physician Payment Review Commission, which was disbanded in 1997 and replaced by the Medicare Payment Advisory Commission. Commissioners in the Medicare Payment Advisory Commission became highly critical of the RBRVS and the RUC and made their feelings clear in their June 2006 report to Congress. That criticism has been repeated in every annual report since then and resulted in the misvalued codes endeavor legislated in the Affordable Care Act. That legislation encouraged Centers for Medicare & Medicaid Services to conduct their own surveys and to employ independent contractors to analyze physician services.

Despite efforts to correct the system, cognitive services remain undervalued. For example, compare the valuation of screening colonoscopy (Current Procedural Terminology code [CPT] 45378) to the first hour of critical care (CPT 99291), recognizing that taking responsibility for a physiologically unstable patient requires not only a significant fund of knowledge and the ability to apply best practice recommendations that are constantly evolving, often on a month-to-month basis, but also the ability to deal with family dynamics in an emotionally charged situation. For the 2014 Medicare Physicians Fee Schedule, CPT 45378 is valued at 6.19 relative value units while 99291 is valued at 6.26 relative value units. Our societies have had representation at the RUC since its inception with no notable change in the value of codes specific to our services. We can hope that with more articles such as those by Laugesen1 and Kumetz and Goodson,2 societies representing our practice domain will actively engage in efforts to improve this flawed system.

References

Laugesen MJ. The Resource-Based Relative Value Scale and physician reimbursement policy. Chest. 2014;146(5):1413-1419. [CrossRef] [PubMed]
 
Kumetz EA, Goodson JD. The undervaluation of evaluation and management professional services: the lasting impact of Current Procedural Terminology code deficiencies on physician payment. Chest. 2013;144(3):740-745. [CrossRef] [PubMed]
 

Figures

Tables

References

Laugesen MJ. The Resource-Based Relative Value Scale and physician reimbursement policy. Chest. 2014;146(5):1413-1419. [CrossRef] [PubMed]
 
Kumetz EA, Goodson JD. The undervaluation of evaluation and management professional services: the lasting impact of Current Procedural Terminology code deficiencies on physician payment. Chest. 2013;144(3):740-745. [CrossRef] [PubMed]
 
NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Some tools below are only available to our subscribers or users with an online account.

Related Content

Customize your page view by dragging & repositioning the boxes below.

Find Similar Articles
  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543