Medicare reimbursement: an orthopedic primer

Since 1992, Medicare has paid physicians and other practitioners by using a resource-based relative value scale system (RBRVS). The Center for Medicare Services updates the RBRVS annually and reviews the work portion for each procedure every 5 years. The calculation of the work units is done by using a survey. This survey polls the average amount of time spent in each portion of the case. The survey process is quite complex. Some of the specific biases that can be found include rank lists, multidimensional, hypothetical items, and complexity and memory overload bias. Survey errors are easy to make over and above item bias. With this system, surgeons are encouraged to be slower to increase their compensation. Surveying methodology is not the most appropriate way to tabulate time and work. Unless this methodology changes, orthopedic surgeons will continue to be shortchanged.