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Resource-Based Relative Value Scales: impacts and recommendations relative to chiropractic practice
R D Mootz1, J A Hess, A D McMillin
1State of Washington Department of Labor and Industries, Olympia, Washington 98504-4321, USA.
Summary
Chiropractic lacks data for Medicare reimbursement under the resource-based relative value scale (RBRVS). Research is needed to establish work values, practice costs, and service codes for chiropractors to ensure equitable inclusion in evolving healthcare payment systems.
Area of Science:
- Health Services Research
- Health Economics
- Chiropractic Research
Background:
- The American healthcare system is undergoing rapid changes in financing and delivery.
- Medicare's resource-based relative value scale (RBRVS) is a national standard for physician service reimbursement.
- Existing RBRVS data cover most medical specialties but lack chiropractic-specific information.
Purpose of the Study:
- To review the relevance of RBRVS to chiropractic practice.
- To discuss work levels and practice costs within chiropractic.
- To propose a research and policy agenda for documenting chiropractic services and costs for reimbursement.
Main Methods:
- A systematic literature review of medical and chiropractic publications.
- Analysis of payer and trade association data on chiropractic work value and practice costs.
- Review of governmental payment scales.
Main Results:
- No current data exist on chiropractic work levels and practice costs within the RBRVS framework.
- This data gap may impede chiropractic's inclusion in evolving reimbursement schemes.
- The RBRVS system's development and implementation for physician services were characterized.
Conclusions:
- Urgent resources are needed to survey chiropractor work levels using standardized methodology.
- Development and testing of generic manipulation codes are recommended for inclusion in CPT.
- Systematic documentation of practice overhead costs and malpractice risk is essential.