Resource-based Relative Value Scale - Criticism

Criticism

The RBRVS system has been criticized on a number of grounds:

• Paying based on effort rather than effect skews incentives, leading to overuse of complicated procedures without consideration for outcomes. Contrast with evidence-based medicine (EBM), which is based on outcomes.

  According to this critique, RBRVS misaligns incentives: because the medical value to the patient of a service is not included in how much is paid for the service, there is no financial incentive to help the patient, nor to minimize costs. Rather, payment is partly based on difficulty of the service (the "physician work" component), and thus a profit-maximizing physician is incentivized to provide maximally complicated services, with no consideration for effectiveness.

  One effect attributed to RBRVS is a lack of primary care physicians (PCPs) at the expense of specialists – because specialist services require more effort and specialized training, they are paid more highly, incentivizing physicians to specialize, leading to a lack of PCPs.

• The Specialty Society Relative Value Scale Update Committee (RUC) is largely privately run, an example of regulatory capture.
• RUC is secretive, with the meetings being closed to the public and uninvited observers.
• The data are effectively copyrighted by the AMA, but its use is required by statute.

  Although the RBRVS system is mandated by the Centers for Medicare and Medicaid Services (CMS) and the data for it appears in the Federal Register, the American Medical Association (AMA) maintains that their copyright of the CPT allows them to charge a license fee to anyone who wishes to associate RVU values with CPT codes. The AMA receives approximately $70 million annually from these fees, making them reluctant to allow the free distribution of tools and data that might help physicians calculate their fees accurately and fairly.