RBRVS - The politics This series is personal recollection. A few details may be a little off the mark - though not enough to undermine the message.
Before the discussion of politics it is only fair to make a brief assessment of the system. The resource based relative scale (RBRVS) has gotten a lot of bad press because of lack of understanding and political manipulation. Sadly the term "managed care" in this country has deteriorated into a system "bureaucratic care", or red tape barrier to access. The dysfunctional health care payment system in the United States is largely the result of competitive plans presenting varying schemes of skimming a layered percentage of expenditure for their role in "cost management." Many left the American Medical Association (AMA) Interim meeting in December 1989 with the feeling that, with the AMA endorsement of RBRVS, we had a standard by which to measure progress and time would give us a better idea of direction. I purchased the first RBRVS diskette release and as I started analyzing the file, I was surprised to find compensation for family physicians had not improved as anticipated. The Bush(1)administration, though promising "revenue neutral" transition, had removed "highly compensated" specialists from the formula. This maneuver was both simple, since the Federal government had dealt with the radiologists, pathologists, and anesthesiologists before the RBRVS was completed, and quiet, since the media, newspapers and journalists were NOT sensitive to and, indeed, did not understand, our plight. After adapting the RBRVS for our schedule, we discovered another weakness. A general surgeon in our group pointed out that Blue Cross allowed three times the RBRVS fees for most surgery. (I recalled Dr. Hsiao's comment about 35 cents on the dollar, and now here it was looming over billing.) We decided we could not leave that kind of money on the table, even if the surgeon would tolerate it. We added a modifier, for special fee adjustment, to the formula. The Tennessee Academy of Family Physicians adopted, and sent on to the American Academy of Family Physicians, a resolution asking the AAFP to promote the idea and lobby commercial carriers to convert to the RBRVS payment scale. The expectation was a "revenue neutral" conversion, however there was a preponderance of proceduralists in the leadership of the AAFP whose goal was to retain the proceduralist-oriented scale and fight instead for added privileges - family physicians doing more procedures. This setback left an imbalanced payment system and as late as 2004 Blue Cross of Tennessee met severe opposition when they announced plans to adopt the RBRVS for their fee for service contracts. A clear understanding of the RBRVS and discounting is essential to designing a practice accounts receivable and management system. The next installment deals with adapting the RBRVS to effective electronic accounts management. ------------------------------------------------------- SF email is sponsored by - The IT Product Guide Read honest & candid reviews on hundreds of IT Products from real users. Discover which products truly live up to the hype. Start reading now. http://ads.osdn.com/?ad_id=6595&alloc_id=14396&op=click _______________________________________________ Hardhats-members mailing list Hardhats-members@lists.sourceforge.net https://lists.sourceforge.net/lists/listinfo/hardhats-members
