A critique of the Harvard Resource-Based Relative Value Scale

Area of Science:

• Health Policy
• Medical Economics
• Physician Payment Systems

Background:

• Physician payment reform is a critical aspect of national health policy discussions.
• The Harvard Resource-Based Relative Value Scale (RBRVS) is a central element in this debate.
• Understanding the RBRVS's methodological assumptions and limitations is crucial for evaluating its utility.

Purpose of the Study:

• To critically examine the methodological assumptions and compromises made in the development of the Harvard RBRVS.
• To identify specific weaknesses and anomalies within the Harvard RBRVS system.
• To highlight areas requiring further investigation for improving physician work valuation.

Main Methods:

• Analysis of the methodological assumptions underpinning the Harvard RBRVS.
• Identification of limitations in case selection and input from clinical practice.
• Evaluation of the extrapolation methodology used for non-surveyed physician services.

Main Results:

• The Harvard RBRVS study surveyed insufficient cases, limiting its representation of clinical practice diversity.
• Limited inter-specialty input on case equivalence led to potential inaccuracies.
• An unproven extrapolation methodology resulted in anomalies, such as lower values for comprehensive services for new patients and inconsistencies between Internal Medicine and Family Practice new patient office visit values.

Conclusions:

• The Harvard RBRVS is a significant contribution to understanding physician practice but is not a definitive system.
• Methodological assumptions and identified anomalies require further investigation and explanation.
• Refinement of the RBRVS is necessary to accurately reflect the complexity of physician work.