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.
Read more about this topic: Resource-based Relative Value Scale
Famous quotes containing the word criticism:
“Unless criticism refuses to take itself quite so seriously or at least to permit its readers not to, it will inevitably continue to reflect the finicky canons of the genteel tradition and the depressing pieties of the Culture Religion of Modernism.”
—Leslie Fiedler (b. 1917)
“The aim of all commentary on art now should be to make works of art—and, by analogy, our own experience—more, rather than less, real to us. The function of criticism should be to show how it is what it is, even that it is what it is, rather than to show what it means.”
—Susan Sontag (b. 1933)
“However intense my experience, I am conscious of the presence and criticism of a part of me, which, as it were, is not a part of me, but a spectator, sharing no experience, but taking note of it, and that is no more I than it is you. When the play, it may be the tragedy, of life is over, the spectator goes his way. It was a kind of fiction, a work of the imagination only, so far as he was concerned.”
—Henry David Thoreau (1817–1862)