CHEST Guidelines-The Critical Flaw in Physician Compensation Is Not...

The Critical Flaw in Physician Compensation Is Not...

Pdf Summary

The correspondence highlights significant flaws in the physician compensation system, focusing particularly on the Resource-Based Relative Value Scale (RBRVS) rather than the sustainable growth rate. Dr. James A. L. Mathers points out that two articles in <em>CHEST</em> by Laugesen and by Kumetz and Goodson have shed light on the complexity and inequality of physician compensation under the RBRVS system, especially regarding cognitive versus procedural services. 

The RBRVS framework, initially crafted for procedural services, later incorporated cognitive services, but these have remained undervalued. This undervaluation persists despite the legislative requirement for regular reviews set forth by the American Medical Association's Relative Value Scale Update Committee (RUC). However, the RUC's membership has been dominated by procedural specialties, leading to ongoing biases in valuations. 

Efforts have been made to address these biases; for instance, the Medicare Payment Advisory Commission has been consistently critical of the RBRVS and the RUC since a 2006 report to Congress. Ultimately, the Affordable Care Act led to initiatives like the misvalued codes endeavor, encouraging independent analysis of physician services.

Despite such efforts, cognitive services continue to be undervalued as exemplified by a comparison of the valuation for a screening colonoscopy and the first hour of critical care, both of which receive similar relative value units despite differing complexities and responsibilities.

Dr. Mathers urges societies representing cognitive-service-dominant specialties to actively seek reform in the valuation process, influenced by works like those of Laugesen and Kumetz and Goodson, to prompt change in the RUC and rectify this flawed compensation system. He discloses no conflicts of interest in his analysis. 

The article emphasizes the need for ongoing scrutiny and reform in how physician services are valued, particularly those requiring significant cognitive skills.

Keywords

physician compensation

Resource-Based Relative Value Scale

RBRVS

cognitive services

procedural services

valuation biases

Medicare Payment Advisory Commission

Affordable Care Act

misvalued codes

Relative Value Scale Update Committee