ARCHEOLOGY: This series begins a discussion of medical account receivable. RBRVS is an important part of billing. Therefore, a recap of how RBRVS came about seems in order. This series is personal recollection. A few details may be a little off the mark - though not enough to undermine the message.
Medicare launched about the same time I entered practice - 1965. My community had five surgeons and five primary care physicians. Since the primary care physicians had far more than we could do and the surgeons were often idle, we abdicated most of our procedures to the surgeons. Then, general practitioners could generate more revenue in the office than in the ER or the hospital. During this period, the proceduralists began escalating charges . not difficult because the co-pay was forgiven and the patient paid NOTHING for proceduralists. I had countless patients tell me about wonderful proceduralist X, who meanwhile was not complying with the law. In those days GPs/FPs (including me) also did procedures/surgery. Surprisingly, the feds started closing in first on primary care. Our first experience was around 1969 when suddenly we were getting paid $2.00 less for each office visit. On investigation, they had learned we were doing a urinalysis each visit, a standard practice in those days. They concluded since patient visit X had no real need (diagnosis) for a urinalysis and the allowed fee for urinalysis was $2.00, the OV fee could be reduced from $7.00 to $5.00. This fee was never recovered and we treated it as a "learning moment." In the meantime, the inflationary spiral of surgical fees continued unabated, while primary care physicians could no longer file for lab not done in our offices and we still looked to the patient to pay the deductible. The early 70's brought price controls. Those of us who had followed the AMA plea to hold the line on fees voluntarily were hit hardest by the freeze. (The AMA purportedly had a promise from President Richard Nixon of no fee freeze.) Physicians who had continued unabated fee increases were two steps ahead when fees were frozen. After the freeze thawed, all (Medicare) fees were gauged by a medical price index (MPI) - and went forward in lockstep - with no chance of closing the gap with the proceduralists. For instance, at 5% inflation, a $1000 surgical procedure was allowed a $50 increase and a $30 office charge was raised only $1.50. While it seemed fair that everyone was on the same schedule, it isn't hard to see that a $1.50 increase in disposable income didn't compete well with $50. The leverage created by that divide was a remarkable asset to the proceduralists and a burden to the system. The feds then threatened, base on breach of law, to reduce procedure fees for those not collecting the co-pay - not well received by proceduralists. This environment brought us to the dysfunctional system that gave birth to RBRVS. ------------------------------------------------------- This SF.Net email is sponsored by: IntelliVIEW -- Interactive Reporting Tool for open source databases. Create drag-&-drop reports. Save time by over 75%! Publish reports on the web. Export to DOC, XLS, RTF, etc. Download a FREE copy at http://www.intelliview.com/go/osdn_nl _______________________________________________ Hardhats-members mailing list Hardhats-members@lists.sourceforge.net https://lists.sourceforge.net/lists/listinfo/hardhats-members
