Results, potential effects, and implementation issues of the Resource-Based Relative Value Scale

JAMA. 1988 Oct 28;260(16):2429-38.


This article presents the overall results of the Resource-Based Relative Value Scale (RBRVS) study. We present resource-based relative values for selected services in each of the 18 specialties we studied. We found that preservice and postservice work represents close to 50% of total work for invasive services and 33% of total work for evaluation/management services. We also found that the work per unit time (a measure of intensity) for invasive services is about three times that of evaluation/management. We developed a simple model and simulated an RBRVS-based fee schedule for the Medicare program under a "budget-neutral" assumption. Results for 30 commonly performed services show that office visit fees for evaluation/management services could rise by 70%, while some surgical fees could drop by 60%. We also simulated what the Medicare outlays would have been in 1986 for categories of medical services under an RBRVS-based fee schedule. We found that total Medicare payments for evaluation/management services would have increased by about 56%. Invasive, imaging, and laboratory services would have decreased by 42%, 30%, and 5%, respectively. We also discuss implementation issues related to an RBRVS-based fee schedule, such as the determination of a monetary conversion factor, practice costs, billing codes, and the need to evaluate the potential impacts of an RBRVS-based payment system on the cost and quality of health care.

Publication types

  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Costs and Cost Analysis
  • Economics, Medical*
  • Fee Schedules / standards*
  • Health Services Research*
  • Internship and Residency / economics
  • Medicare
  • Models, Theoretical
  • Practice Patterns, Physicians' / economics
  • Research Design
  • Specialization*
  • United States
  • Work*