Panel processes for revising relative values of physician work. A pilot study

Area of Science:

• Health Economics
• Medical Policy
• Physician Payment

Background:

• The Medicare Resource-Based Relative Value Scale (RBRVS) requires regular revision to accurately reflect physician work.
• Previous methods for updating RBRVS values may not fully capture the nuances of physician effort across specialties.
• A need exists for a practical and reliable method to refine relative work values.

Purpose of the Study:

• To pilot a group-discussion-based method for revising the Medicare RBRVS.
• To evaluate the practicality of using a reference set of services with agreed-on values for revising RBRVS.
• To assess the evolution of the group discussion method over a series of meetings.

Main Methods:

• Conducted four pilot panels with 46 physicians from diverse specialties.
• Utilized a reference set of services with graphically displayed values for magnitude estimation.
• Collected physician preliminary/final ratings and detailed discussion notes.
• Pilots included rating specific urologic and ophthalmologic services, and appeals for other services.

Main Results:

• The panel process for refining relative work values was found to be practical.
• Providing panelists with a valid reference set is crucial for the method's success.
• Ensuring all members feel comfortable engaging in discussions is essential for effective group processes.

Conclusions:

• The piloted group discussion method is a viable approach for updating RBRVS values.
• The Health Care Financing Association and AMA RBRVS Update Committee have adopted similar methods.
• This approach facilitates the determination of relative work values for physician services.