The Resource-Based Relative Value Scale. Methods, results, and impacts for ophthalmology
D. K. Verrilli, D. L. Dunn and L. Rand
Urban Institute, Washington, DC.
In January 1992, the Health Care Financing Administration implemented
sweeping legislation that reformed the way Medicare pays for physicians'
services. The cornerstone of the reform consists of a new fee schedule
based on the Resource-Based Relative Value Scale. This article summarizes
the methods and data used to derive the scale for ophthalmology. The
results and impacts of the new Medicare payment rates for ophthalmology are
also assessed. Using our methods and assumptions, ophthalmologists stand to
lose 16% of their Medicare revenues under a fully implemented relative
value-based fee schedule. Overall, the fees for performing evaluation and
management services will increase, while those for most surgical procedures
and diagnostic tests will decrease. Physicians' practice decisions and
medical students' specialty choices could be affected. Ophthalmologists who
perform work-intensive surgical procedures and spend the majority of their
time in the operating room will continue to earn much higher incomes than
those who do not.
