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October 28, 1988, Vol 260, No. 16 >
ARTICLE | October 28, 1988

Resource-Based Relative Values: Title and subTitle BreakAn Overview FREE

William C. Hsiao, PhD; Peter Braun, MD; Daniel Dunn, PhD; Edmund R. Becker, PhD
[+] Author Affiliations

The opinions expressed herein are those of the authors and do not necessarily reflect the views of the Health Care Financing Administration, the Commonwealth Fund, the Kaiser Foundation, or the Kellogg Foundation.

Reprint requests to Physician Payment-Relative Value Study, Harvard University School of Public Health, 677 Huntington Ave, Kresge, Third Floor, Boston, MA 02115 (Dr Hsiao).


JAMA. 1988;260(16):2347-2353. doi:10.1001/jama.1988.03410160021004
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References

Studies have been conducted over the past decade to develop a Resource-Based Relative Value Scale (RBRVS) for physicians' services. Policymakers view an RBRVS as a potential tool to pay physicians. The Physician Payment Review Commission, under a congressional mandate, has endorsed the general concept of a fee schedule based on resource costs for physician payment under Medicare. In this overview article, we present the policy context in which the RBRVS may play a role and describe the approach taken to develop this scale, specifically consultation with clinicians, researchers, and insurers and data gathering, including a national survey of physicians. We discuss underlying elements that are necessary to constructing an RBRVS, each of which is described more fully in subsequent articles: measuring the work (intraservice work) of performing medical services and procedures, estimating preservice and postservice work, comparing work across specialties, measuring practice costs, extrapolating from surveyed services, and establishing an RBRVS for evaluation/management services and for invasive procedures. Overall results are presented in a companion article.

(JAMA 1988;260:2347-2353)

REFERENCES

1 +
Hearings Before the Subcommittee on Health of the House Committee on Ways and Means , 100th Cong, 2nd sess (1988;) (testimony of William L. Roper, MD, administrator, Health Care Financing Administration).
2 +
Annual Report to Congress . Washington, DC, Physician Payment Review Commission, 1988;.
3 +
Greenspan AM, Kay HR, Berger BC, et al:  Incidence of unwarranted implantation of permanent cardiac pacemakers in a large medical population . N Engl J Med 1988;;318:158-163.
4 +
Chassin MR, Kosecoff J, Park RE, et al:  Does inappropriate use explain geographic variations in the use of health care services? A study of three procedures . JAMA 1987;;258:2533-2537.
5 +
Graduate Medical Education National Advisory Committee: Summary Report to the Secretary , publication (HRA) 86-651. US Dept of Health and Human Services, 1981;.
6 +
Medicare Physician Reimbursement: An AMA Perspective . Chicago, American Medical Association, 1987;.
7 +
Hsiao WC, Braun P, Becker ER, et al:  The resource-based relative value scale: Toward the development of an alternative physician payment system . JAMA 1987;;258:799-802.
8 +
Medicare Physician Payment: An Agenda for Reform . Washington, DC, Physician Payment Review Commission, 1987;.
9 +
Hsiao WC, Stason WB:  Toward developing a relative value scale for medical and surgical services . Health Care Financing Rev 1979;;1:23-28.
10 +
Hsiao WC, Braun P, Goldman P, et al: Resource-Based Relative Values of Selected Medical and Surgical Procedures in Massachusetts: Final Report on Research Contract for Rate Setting Commission, Commonwealth of Massachusetts . Boston, Harvard University School of Public Health, 1985;.
11 +
Hadley J, Juba D, Berenson R, et al: Final Report on Alternative Methods of Developing a Relative Value Scale of Physicians' Services . Washington, DC, The Urban Institute, 1984;.
12 +
Egdahl RH, Manuel B:  A consensus process to determine the relative complexity-severity of frequently performed surgical services . Surg Gynecol Obstet 1985;;160:403-406.
13 +
Fanta CM, Finkel AJ, Kirshner CG, et al: Physicians' Current Procedural Terminology , ed 4. Chicago, American Medical Association, 1986;.
14 +
Hsiao WC, Yntema DB, Braun P, et al:  Measurement and analysis of intraservice work . JAMA 1988;;260:2361-2370.
15 +
Dunn D, Hsiao WC, Ketcham TR, et al:  A method for estimating the preservice and postservice work of physicians' services . JAMA 1988;;260:2371-2378.
16 +
Braun P, Yntema DB, Dunn D, et al:  Crossspecialty linkage of Resource-Based Relative Value Scales: Linking specialties by services and procedures of equal work . JAMA 1988;;260:2390-2396.
17 +
Kelly NL, Hsiao WC, Braun P:  Extrapolation of measures of work for surveyed services to other services . JAMA 1988;;260:2379-2384.
18 +
Becker ER, Dunn D, Hsiao WC:  Relative cost differences among physicians' specialty practice . JAMA 1988;;260:2397-2402.
19 +
Braun P, Hsiao WC, Becker ER, et al:  Evaluation and management services in the Resource-Based Relative Value Scale . JAMA 1988;;260:2409-2417.
20 +
Hsiao WC, Couch NP, Causino N, et al:  Resource-based relative values for invasive procedures performed by eight surgical specialties . JAMA 4988;;260:2347-2353.
21 +
Hsiao WC, Braun P, Kelly NL, et al:  Results, potential effects, and implementation issues of the Resource-Based Relative Value Scale . JAMA 1988;;260:2429-2438.
22 +
Hsiao WC, Braun P, Becker ER, et al: A National Study of Resource-Based Relative Value Scales for Physician Services: Final Report to the Health Care Financing Administration , publication 17-C-98795/1-03. Boston, Harvard University School of Public Health, 1988;.
23 +
Wechsler H: Handbook of Medical Specialties . New York, Human Sciences Press, 1976;.
24 +
Surgical Prevailing Health Care Charges System . Washington, DC, Health Insurance Association of America, 1987;.
25 +
Florida Relative Value Studies 1986 . Jacksonville, Florida Medical Association, 1986;.
26 +
1969 Relative Value Studies . San Francisco, California Medical Association, 1969;.
27 +
Hsiao WC, Braun P, Yntema D, et al:  Estimating physicians' work for a Resource-Based Relative Value Scale . N Engl J Med 1988;;319:835-841.
28 +
Mosteller F, Tukey JW: Data Analysis and Regression: A Second Course in Statistics . Reading, Mass, Addison-Wesley Publishing Co, 1977;, pp 133-163.
29 +
Gonzalez ML: Socioeconomic Characteristics of Medical Practice 1987 . Chicago, American Medical Association, 1987;.
30 +
Owens A:  Doctor's earnings: On the rise again? Med Economics 1987;;65:212-237.

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
Hearings Before the Subcommittee on Health of the House Committee on Ways and Means , 100th Cong, 2nd sess (1988;) (testimony of William L. Roper, MD, administrator, Health Care Financing Administration).
2 +
Annual Report to Congress . Washington, DC, Physician Payment Review Commission, 1988;.
3 +
Greenspan AM, Kay HR, Berger BC, et al:  Incidence of unwarranted implantation of permanent cardiac pacemakers in a large medical population . N Engl J Med 1988;;318:158-163.
4 +
Chassin MR, Kosecoff J, Park RE, et al:  Does inappropriate use explain geographic variations in the use of health care services? A study of three procedures . JAMA 1987;;258:2533-2537.
5 +
Graduate Medical Education National Advisory Committee: Summary Report to the Secretary , publication (HRA) 86-651. US Dept of Health and Human Services, 1981;.
6 +
Medicare Physician Reimbursement: An AMA Perspective . Chicago, American Medical Association, 1987;.
7 +
Hsiao WC, Braun P, Becker ER, et al:  The resource-based relative value scale: Toward the development of an alternative physician payment system . JAMA 1987;;258:799-802.
8 +
Medicare Physician Payment: An Agenda for Reform . Washington, DC, Physician Payment Review Commission, 1987;.
9 +
Hsiao WC, Stason WB:  Toward developing a relative value scale for medical and surgical services . Health Care Financing Rev 1979;;1:23-28.
10 +
Hsiao WC, Braun P, Goldman P, et al: Resource-Based Relative Values of Selected Medical and Surgical Procedures in Massachusetts: Final Report on Research Contract for Rate Setting Commission, Commonwealth of Massachusetts . Boston, Harvard University School of Public Health, 1985;.
11 +
Hadley J, Juba D, Berenson R, et al: Final Report on Alternative Methods of Developing a Relative Value Scale of Physicians' Services . Washington, DC, The Urban Institute, 1984;.
12 +
Egdahl RH, Manuel B:  A consensus process to determine the relative complexity-severity of frequently performed surgical services . Surg Gynecol Obstet 1985;;160:403-406.
13 +
Fanta CM, Finkel AJ, Kirshner CG, et al: Physicians' Current Procedural Terminology , ed 4. Chicago, American Medical Association, 1986;.
14 +
Hsiao WC, Yntema DB, Braun P, et al:  Measurement and analysis of intraservice work . JAMA 1988;;260:2361-2370.
15 +
Dunn D, Hsiao WC, Ketcham TR, et al:  A method for estimating the preservice and postservice work of physicians' services . JAMA 1988;;260:2371-2378.
16 +
Braun P, Yntema DB, Dunn D, et al:  Crossspecialty linkage of Resource-Based Relative Value Scales: Linking specialties by services and procedures of equal work . JAMA 1988;;260:2390-2396.
17 +
Kelly NL, Hsiao WC, Braun P:  Extrapolation of measures of work for surveyed services to other services . JAMA 1988;;260:2379-2384.
18 +
Becker ER, Dunn D, Hsiao WC:  Relative cost differences among physicians' specialty practice . JAMA 1988;;260:2397-2402.
19 +
Braun P, Hsiao WC, Becker ER, et al:  Evaluation and management services in the Resource-Based Relative Value Scale . JAMA 1988;;260:2409-2417.
20 +
Hsiao WC, Couch NP, Causino N, et al:  Resource-based relative values for invasive procedures performed by eight surgical specialties . JAMA 4988;;260:2347-2353.
21 +
Hsiao WC, Braun P, Kelly NL, et al:  Results, potential effects, and implementation issues of the Resource-Based Relative Value Scale . JAMA 1988;;260:2429-2438.
22 +
Hsiao WC, Braun P, Becker ER, et al: A National Study of Resource-Based Relative Value Scales for Physician Services: Final Report to the Health Care Financing Administration , publication 17-C-98795/1-03. Boston, Harvard University School of Public Health, 1988;.
23 +
Wechsler H: Handbook of Medical Specialties . New York, Human Sciences Press, 1976;.
24 +
Surgical Prevailing Health Care Charges System . Washington, DC, Health Insurance Association of America, 1987;.
25 +
Florida Relative Value Studies 1986 . Jacksonville, Florida Medical Association, 1986;.
26 +
1969 Relative Value Studies . San Francisco, California Medical Association, 1969;.
27 +
Hsiao WC, Braun P, Yntema D, et al:  Estimating physicians' work for a Resource-Based Relative Value Scale . N Engl J Med 1988;;319:835-841.
28 +
Mosteller F, Tukey JW: Data Analysis and Regression: A Second Course in Statistics . Reading, Mass, Addison-Wesley Publishing Co, 1977;, pp 133-163.
29 +
Gonzalez ML: Socioeconomic Characteristics of Medical Practice 1987 . Chicago, American Medical Association, 1987;.
30 +
Owens A:  Doctor's earnings: On the rise again? Med Economics 1987;;65:212-237.

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