The Resource-Based Relative Value Scale

THE Health Care Financing Administration (HCFA) introduced on January 1,1992, a fee schedule1for physician payment under Medicare based on the resource-based relative value scale (RBRVS) of Hsiao et al.2In 1988, the then—chief administrator of HCFA outlined in detail why RBRVS was inappropriate for reform of the Medicare payment system3(a skepticism that is said to persist within HCFA today). Congress nevertheless mandated the use of the RBRVS by HCFA. I criticized the RBRVS4for, among other things, the fact that the scale attempts to establish relative values among specialties based on the putative value of different types of work without considering that some specialties are known to work many more hours per week than others. Fairness in designing a payment system requires that hourly reimbursement rates be computed. See also p 3313. The Commentaries of Hsiao et al5and Radecki et al6