Disclaimer: This series is personal recollection. A few details may be a little off the mark - though not enough to undermine the message.
This issue is best understood with the background of three websites. The first is an interview with William Hsiao, PhD. http://www.cms.hhs.gov/about/history/hsiao.asp The second is the RBRVS spreadsheet provided by SVMIC, the physician owned liability carrier for Tennessee. http://www.svmic.com/ click "medical practice services" "2004 Medicare Fee" Third: More about Dr. Hsiao: http://www.hsph.harvard.edu/faculty/WilliamHsiao.html In December of 1989 (approximately), physicians representing all the States of the U.S. gathered in Dallas, TX for the AMA Interim meeting. The goal was to develop a position on the RBRVS. However, initial discussions revealed a wide and contentious gap between proceduralist and non-proceduralist. All specialties were represented, except for the American College of Surgeons (ACS), though many individual advocates of the ACS were present. William Hsiao, PhD, a Harvard Professor, healthcare economist, and the principal architect of the new RBRVS was invited, by the American Academy of Family Physicians, to describe the program design and to answer questions for the AAFP contingent of the AMA House of Delegates. The family physicians were skeptical but willing to listen, while the proceduralists, in separate sessions, with their own advocates, were determined to defeat any endorsement. The debates in the 1989 AMA reference committees were sometimes bitter and occasionally rancorous. In the AAFP membership briefing Dr. Hsiao presented an analysis of a remarkably thorough and objective study; he reported family physicians' compensation was only $.35 compared to the surgeons' $1.00 for work of equal value. Dr. Hsiao used ophthalmology and cataract surgery, performed at a cost of about $1,000, as an example. One member then recalled the case of an 80 year-old woman, nearly blind until cataract removal resulted in markedly improved interaction and outlook. This physician opined the ophthalmologist had been deservedly well-compensated for this remarkable outcome. Dr. Hsaio, a dignified gentleman with very thick glasses, replied, "Yes, this is a very valuable service. But, you see, there is a market for usefulness that has not been met by Medicare. This surgical procedure must be weighed against a set of spectacles enabling a child, otherwise nearly blind, to see. What is the relative value?" Listening to that interchange, I, and I think most other physicians in the audience, considered Dr. Hsiao and his life work without the aid of corrective lenses . likely a laborer instead of a Harvard PhD economist. By the end of the week, the AMA House had agreed to "endorse" the RBRVS and the meeting ended on a congenial, if somber, note. No one appreciated how the politics of RBRVS implementation could sabotage our expectations. Nevertheless, those left feeling abused and unappreciated in the wake of the RBRVS may consider the pre-RBRVS primary care compensation, working for a relative one third of the surgeons' salary. Remember, these comparisons are relevant to Medicare, with another, separate set of rules applicable to commercial carriers. The next RBRVS installment covers the impact of politics on a dysfunctional U.S. medical reimbursement system. ------------------------------------------------------- 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
