The Resource-Based Relative Value Scale

To the Editor.  Hsiao and associates¹ published the results of their attempt to develop an alternative method of physician reimbursement by Medicare. At the heart of their proposed reform is the Resource-Based Relative Value Scale— a fee schedule designed to replace the "customary, prevailing, and reasonable" method of determining reimbursement currently in use.Much impetus for this study came from those who believe that nonprocedural services (so-called cognitive services) are reimbursed inequitably compared with procedural services. Physicians who do not perform procedures as part of their overall provision of patient care, and organizations dominated by these physicians, are strong supporters of this study and have received the results enthusiastically. On the other hand, many other physicians believe that an attempt to label services as cognitive and procedural is illusory and belittling to physicians, both internists and surgeons, whose diagnostic and therapeutic repertoire includes performing procedures. The American College of