Resource-based Relative Value Scale Research Articles

A decision analysis of treatments for nonobstructive azoospermia associated with varicocele

To examine the economic impact of initial treatments for varicocele-associated nonobstructive azoospermia, specifically varicocelectomy versus microsurgical testicular sperm extraction (TESE) with IVF/intracytoplasmic sperm injection (ICSI). Decision analytic model based on 1) outcomes data from Society for Assisted Reproductive Technology (SART) database and peer-reviewed literature and 2) costing data from Medicare Resource-Based Relative Value Scale and sampling of high volume US IVF centers. Academic medical center. Simulation with a decision analytic model. Variation of successful spontaneous live delivery after varicocelectomy versus rate of successful live delivery after IVF/ICSI. Cost-effectiveness. Microsurgical TESE was more cost effective than varicocelectomy. In 1999, initial treatment with microsurgical TESE was more cost effective ($65,515) than varicocelectomy ($76,878). Relative cost-effectiveness was unchanged in 2005: $69,731 versus $79,576. The cost-effectiveness of both treatments improved in relation to projections by inflation. Sensitivity analyses suggest that the relative cost-effectiveness of TESE versus varicocelectomy can only be changed with either substantial improvement in spontaneous live delivery rates after varicocelectomy or with deterioration in IVF success rates. Microsurgical TESE appears to be more cost effective than varicocelectomy for treatment of varicocele-associated nonobstructive azoospermia when indirect costs are considered. The cost-effectiveness of both treatments has improved with time. These results may be tailored with institution-specific data to allow more individualized results.

The Value of Using the Medicare Resource-Based Relative Value Scale in Your Practice

How to calculate your practice conversion factor when using RBRVS

Lessons Learned From Advanced Practice Nursing Payment

For more than 25 years, advanced practice nurses have been incrementally included as a part of the health care financing structure. Following physician payment revisions at the federal level, advanced practice nurses were overtly recognized as Medicare providers and have participated in the establishment of current procedural terminology codes and the subsequent relative work values associated with payment. Success in this regard has been the result of business, political, and policy savvy that has important lessons for moving forward in any health care restructuring for both nurses and advanced practice nurses. Principles of valuing nurse work, time, and intensity in the Resource-Based Relative Value Scale are discussed with implications for future opportunities of measuring nursing work and any potential relationship to quality outcomes of care.

Unintended Consequences of Resource-Based Relative Value Scale Reimbursement

MEDICINE’S GENERALIST BASE IS DISAPPEARING AS a consequence of the reimbursement system crafted to save it—the resource-based relative value scale. The US physician workforce is unique among developed economies of the world. Virtually all European countries have a broad generalist foundation comprising 70% to 80% of practicing physicians. The United States is the opposite. Starfield has summarized the benefits of a generalist workforce as access to health service for relatively deprived populations; care equal to specialists in most situations (recognizing the invaluable contribution of the specialist physicians but acknowledging that the diffusion of knowledge increases the ability of the nonspecialist to provide up-to-date care); improved preventive service delivery; efficient management of multiple simultaneous medical, surgical, and mental health problems in active and fully functional patients; provision of continuity in the health care experience, advice, and counsel where appropriate and access to appropriate diagnostic, consultative, and specialty services; and, in conjunction, reduced unnecessary specialty testing and consultation. Over the last 4 decades, medical and surgical practice has transformed from a reactive profession to a proactive profession. Evidence from numerous clinical investigations in many different settings shows that patients with any of the 3 most common conditions—hypertension, diabetes, hypercholesterolemia—benefit from early treatment. Conversely, failure to diagnose and treat increases the likelihood of poor outcomes. Well-designed studies have shown that the early and active treatment of disease in the asymptomatic phase has profound lifetime benefits. For instance, the Hypertension Detection and Follow-up Program demonstrated the reduced mortality derived from the early identification and treatment of hypertension with benefits occurring in those managed closely with inexpensive therapies. The Diabetes Control and Complications Trial showed that early and effective management of blood glucose levels for patients with type 1 diabetes reduced long-term risk for neuropathy, retinopathy, and nephropathy. The West of Scotland Study showed that patients with coronary heart disease and risk factors had lower mortality if their low-density lipoprotein cholesterol levels were managed actively. Targets for secondary prevention decreased with successive clinical studies, and targets for primary prevention of heart disease followed suit. The seventh Joint National Committee on the Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) specifies that even the patient with normal blood pressure should be counseled about lifestyle modification to avoid later life development of high blood pressure. The JNC 7 urges clinician empathy for a patient who generally feels well. The implication is that some physicians will convince a patient with a silent disease to change dietary and exercise habits and perhaps take daily medications. The ever-expanding repertoire of interventions, screening tests, vaccines, and devices has dramatically increased the work of patient care for all physician specialties. As an indicator of this ever-expanding content, the total resourcebased relative value units per Medicare beneficiary increased by 45% from 1992 to 2002. For the generalist physician, this increase has been especially intense. Providing all recommended preventive services to a panel of 2500 patients could require up to 71⁄2 hours a day of physician time. Generalist physicians report that roughly 4 separate problems are addressed at each office visit for patients older than 65 years and even more issues are addressed for patients with chronic illnesses such as diabetes. For a hypothetical 79-yearold woman with 5 medical conditions, current clinical practice guidelines would support the use of 12 medications. Attaining the expected health benefits from early and effective treatment of symptomatic and asymptomatic illness will not be achievable without increasing the number of generalists. The United States is now served by highly trained but limited-scope practitioners, at the very time skillful and well-supported primary care physicians are needed. The overall workload is overwhelming the capacity for generalist care if not the individual clinicians. This problem will only be resolved with full recognition of its origins. Because physician decision making profoundly influences health care expenditures, the forces that affect these decisions must be addressed. Practice type and physician specialty are critical factors; both are associated with higher rates of test ordering and hospitalization. Gen-

건강보험 상대가치 개정 연구의 성과와 한계

Relative value scales introduced in 2001 remarkably improved health insurance fee schedule, but current relative value scales have many problems. In the beginning the government intended to introduce 'resource based relative value scales(RBRVSs)' like USA, but political adjustment of RBRVS studied in 19.17 weakened the relationship between relative value scale and resource consumption. So unbalance of health insurance fees are existing till now. Also relative value was not divided to physician work and practice expense, and malpractice fee was not divided separately. To correct the unbalance of current relative value scales, the refinement project of health insurance relative value scales started in 2003. The project team divided relative value scales into three components, which are physician work, practice expense, malpractice fee. Physician work was studied by professional organizations like Korean medical association. To develop the practice expense relative value, project team organized clinical practice expert panels(CPEPs) composed of physicians, nurses, and medical technicians. CPEPs constructed direct expense data like labor costs, material costs, equipment costs about each medical procedures. The practice expense relative values of medical procedures were developed by the allocation of the institution level direct & indirect costs according to CPEPs direct costs. Institution level direct & indirect costs were collected in 21 hospitals, 98 medical clinics, 53 dental clinics, 78 oriental clinics, and 46 pharmacies. The malpractice fee relative values were developed through the survey of malpractice related costs of hospitals, clinics, pharmacies. Putting together three components of relative values in one scale, the final relative values were made. The final relative values were calculated under budget neutrality by medical departments, that is, total relative value score of a department was same before and after the revision. but malpractice fee relative value scores were added to total scores of relative values. So total score of a department was increased by the malpractice fee relative value score of that department This project failed in making 'resource based' relative value scales in the true sense of the word, because the total relative value scores of medical departments were fixed. However the project team constructed the objective basis of relative value scale like physician's work, direct practice expense, malpractice fee. So step by step making process of the basis, the fixation of total scores by the departments will be resolved and the resource based relative value scale will be introduced in true sense.

Why Your State Medicaid Physician Fee Payment Schedule Differs From the Medicare Resource-Based Relative Value Scale

How RBRVS works and how it may affect your practice and payments

Detecting Occult Malignancy in Prophylactic Mastectomy: Preoperative MRI Versus Sentinel Lymph Node Biopsy

High-risk patients undergoing prophylactic mastectomy (PM) may have unsuspected cancers identified on pathology. The optimum way to identify and manage them is controversial. Magnetic resonance imaging (MRI) may identify occult cancer preoperatively. Sentinel lymph node biopsy (SLNB) allows intraoperative staging and axillary dissection during the same operation. We determined the efficacy and cost of MRI and/or SLNB in managing high-risk PM patients. We reviewed 192 PMs in 173 patients from 1999 to 2005. Costs were estimated for MRI and SLNB during PM by the 2005 Medicare Resource-Based Relative Value Scale. We also estimated costs and procedures for the four strategies in a larger hypothetical cohort. A total of 19 (10%) of 192 PMs contained occult cancers, 14 ductal carcinoma-in-situ (DCIS) and 5 invasive ductal carcinoma (IDC). In 59 patients, MRI detected an IDC but missed two DCIS and an IDC. Positive MRIs generated an additional average cost of $1,207 per patient. In 56 PMs with SLNB, 6 occult cancers were found, 5 DCIS and 1 IDC, all with negative SLNBs. Adding a SLNB costs an additional average of $644. A theoretical analysis demonstrated that PM alone costs $808 per patient, PM with SLNB costs $1,420, PM with MRI and selective SLNB costs $1,774, and PM with routine MRI and SLNB costs $2,379. MRI adds great cost and misses most occult cancers in PMs. SLNB allows the rare patient with occult IDC to avoid axillary dissection but adds cost. Given the low rate of unsuspected invasive cancers and the costs of MRI and SLNB, neither is recommended as standard practice for PM patients.

Use of Physicians' Services under Medicare's Resource-Based Payments

In 1992, Medicare implemented the resource-based relative-value scale, which established payments for physicians' services based on relative costs. We conducted a study to determine how the use of physicians' services changed during the first decade after the implementation of this scale. With the resource-based relative-value scale, Medicare payments are based on the number of relative-value units (RVUs) assigned to physicians' services. The total number of RVUs reflects the volume of physicians' work (the time, skill, and training required for a physician to provide the service), practice expenses, and professional-liability insurance. Using national data from Medicare on physicians' services and American Medical Association files on RVUs, we analyzed the growth in RVUs per Medicare beneficiary from 1992 to 2002 according to the type of service and specialty. We also examined this growth with respect to the quantity and mix of services, revisions in the valuation of RVUs, and new service codes. Between 1992 and 2002, the volume of physicians' work per Medicare beneficiary grew by 50%, and the total RVUs per Medicare beneficiary grew by 45%. The quantity and mix of services were the largest sources of growth, increasing by 19% for RVUs for physicians' work and by 22% for total RVUs. Our findings varied among services and specialties. Revised valuation of RVUs was a key source of the growth in RVUs for physicians' work and total RVUs for evaluation and management and for tests. New service codes were the largest drivers of growth for major procedures (accounting for 36% of the growth in RVUs for physicians' work and 35% of the growth in total RVUs), and the quantity and mix of existing services were the largest drivers of growth for imaging. The growth in RVUs for physicians' work was greatest in cardiology (114%) and gastroenterology (72%). The total growth in RVUs was greatest in cardiology (99%) and dermatology (105%). In the first 10 years after the implementation of the resource-based relative-value scale, RVUs per Medicare beneficiary grew substantially. The leading sources of growth varied among service types and specialties. An understanding of these sources of growth can inform policies to control Medicare spending.

Medicare Spending on Physicians — No Easy Fix in Sight

Medicare's method of payment to physicians has been a thorny problem since the program began more than 40 years ago. Medicare's initial method for setting fees mimicked the typical system used by the Blue Shield plans of the 1960s: payment for the lowest of usual, customary, or reasonable fees. Twenty-five years later, the resulting fee schedule made little sense; individual physicians were paid grossly different amounts for providing identical medical services, with large variations across different geographic areas. As a result, Medicare adopted the resource-based relative-value scale in an attempt to tie relative fees to the amount of work and . . .

Prospective Payment: Medicare’s Secret Success Story

Despite its rich intellectual foundations, the health services research field often seems blind to history and naively susceptible to faith-based conventional wisdom. In their new study of Medicare prospective payment, Rick Mayes and Bob Berenson throw off both of these limitations, with illuminating results. Although managed care is widely regarded in policy circles as a noble victory for employers and insurers in the struggle for control of health spending, Mayes and Berenson contend that “the private sector neither initiated this battle nor provided the critical innovation that transformed health care in the United States.” This slender volume offers value on several dimensions. First, it is an explication of recent history that connects the dots from prospective payment to Medicare-based deficit reduction to cost shifting to managed care. By the same token, the story here serves as a bracing corrective to the mythology of market-based reform and the assumption that government’s role in health is inescapably a negative one. Further, policy scholars will relish the intimately detailed examination of the process by which research and ideas are translated into practice, amid all of the unpredictability of politics and circumstance. It is also a readable saga of the life and times of a generation of thinkers and actors who are still among us and who are still riding the train of events set in motion by enactment of the prospective payment system (PPS) in 1983. Text and notes are loaded with colorful recollections and ruminations of former whiz kids who grew older and wiser as the fruits of their labor ripened. Finally, the PPS story is a sobering object lesson in how sharply policy making by disinterested professionals may contrast with the kind of politically and ideologically driven strategy and legislation that is characteristic of the current era. The backstory here, it will be remembered, is that analysts and policymakers recognized in the early 1980s that cost-based provider reimbursement, which Medicare had cloned from the traditional Blue plans, was fueling runaway inflation in health care. Researchers had been tinkering with diagnosis-based reimbursement schemes for years at this point, and notwithstanding the fact that such “administered prices” were anathema to conservative economists, diagnosis-related groups (DRGs) looked like the right fix to officials in Congress and the Reagan administration. “We just pulled them off the shelf,” said Don Moran, then in the Office of Management and Budget. In the heat of the moment, debate was minimal, and details were left to the experts. First-order effects were resoundingly successful. Medicare hospital payment growth dropped from 16.2 percent a year in 1980–83 to 6.5 percent in 1984–87, while hospitals’ financial health improved with increases in efficiency, and patient outcomes showed no discernible damage. Mayes and Berenson explore a panoply of more-nuanced effects, but the mother of unintended consequences in their history is Congress’s eventual discovery that the annual DRG update factor could be a very

Current Procedural Terminology Category II Codes: Pay-for-Performance Measures

<i>Current Procedural Terminology</i> Category II Codes: Pay-for-Performance Measures

New Relative Value Unit for Hearing and Vision Screening and Care Plan Oversight

The Centers for Medicare & Medicaid Services (CMS) have finally assigned relative value units (RVUs) for hearing and vision screening (92551, 99173). RVUs have also been assigned to the codes for care plan oversight of patients residing in a home, domiciliary, or rest home (eg, assisted living facility) (99339, 99340). This is very good news because the majority of payers use the Medicare Resource-Based Relative Value Scale (RBRVS) as their basis for payment and the establishment of RVUs for these services may help you negotiate for coverage and payment.Be sure to check with your payers to determine their coverage of these services.

Revising Medicare's Physician Fee Schedule — Much Activity, Little Change

What garners attention when it comes to Medicare's payment rates for physicians is the annual drama over possible 11th-hour congressional intervention to prevent cuts under the sustainable growth rate formula. But behind the scenes, Medicare policymakers have been focusing on another aspect of the periodic adjustments: the updating of the relative values in the physician fee schedule and the accuracy of the data on which it relies. Since 1992, Medicare has paid physicians through a fee schedule according to a resource-based relative-value scale (RBRVS). This approach was intended to address distortions produced by basing payments on prevailing charges, which had . . .

The 2007 Resource-Based Relative Value Scale

The Centers for Medicare & Medicaid Services published the 2007 Medicare Resource-Based Relative Value Scale (RBRVS) in the Federal Register on December 1, 2006. You can access it on the CMS Web site at www.cms.hhs.gov/PhysicianFeeSched/.Why are these Medicare relative value units (RVUs) so important to your practice? Many state Medicaid programs and other third-party payers use the Medicare RVUs to establish their own payment policies. However, some payers do not use the Medicare RVUs and will establish their own relative values. It is extremely important that each practice understand the basis a payer uses to determine its payment rates.The total RVU for a given Current Procedural Terminology (CPT®) code is the total of all the associated work and expenses (practice and malpractice expenses) based on the national average relative costs. For most codes, practice expenses are established for both facility (eg, hospital) and non-facility (eg, office) settings.A geographic practice cost index (GPCI) is assigned by Medicare to reflect the relative costs associated with physician work, practice expenses, and malpractice expenses in each Medicare locality. A Medicare conversion factor (CF) is then established and used to convert the RVUs into payments for Medicare services. The 2007 Medicare CF is $37.8975, the same as last year.To calculate the Medicare payment rate, multiply the total geographically adjusted RVU (RVUs for physician work, facility or non-facility practice expense, and malpractice expense multiplied by the GPCI for your area or locality) by the Medicare CF.To calculate the non-Medicare payment rate, multiply the total RVU (physician work, facility or non-facility expense, malpractice expense) by a payer-specific or practice CF. (Most payers, including state Medicaid programs, will establish their own CF.)The Table provides you with the Medicare relative values for some of the new and revised 2007 CPT codes. As reported in the November 2006 (Vol 2, No. 2) issue of Pediatric Coding Companion™, revisions have been made to many of the physician work RVUs for 2007. Therefore, the revised relative values for some evaluation and management services have also been provided. You can access the complete list of RVUs and the GPCIs for your area at www.cms.hhs.gov/apps/pfslookup. You may also find an updated list of the most commonly performed pediatric procedures with the associated RVUs at www.aap.org/visit/RBRVSbrochure.pdf.

Congress Rejects Big Cut In Medicare Payment

Back to table of contents Previous article Next article Government NewsFull AccessCongress Rejects Big Cut In Medicare PaymentMark MoranMark MoranSearch for more papers by this authorPublished Online:5 Jan 2007https://doi.org/10.1176/pn.42.1.0001An 11th-hour intervention by Congress averted a scheduled 5 percent across-the-board reduction in reimbursement for physicians and other health care professionals participating in the Medicare program in 2007. However, many physicians, including psychiatrists, will still see a decline in their 2007 reimbursement because of other government adjustments to the fee schedule.On the last day of the session before adjourning for the Christmas recess, Congress approved HR 6111, the Tax Relief and Health Care Act of 2006, which includes a provision eliminating the 5 percent overall payment reduction that was to take effect January 1 as part of an annual update issued by the federal Centers for Medicare and Medicaid (CMS). That update stemmed from a change to the “conversion factor” that is used in the formula to determine physician fees and is adjusted from year to year to maintain budget neutrality.The bill, which at press time was expected to be signed by President Bush, also includes a 1.5 percent “bonus payment” to physicians who voluntarily report certain quality data as part of a CMS pilot program. The 1.5 percent bonus is effective from July 1 to December 31, 2007.Left unaffected by the Congressional action is a separate adjustment to so-called work and practice expense relative value units (RVUs). That adjustment, the result of a recent five-year review of RVUs, is expected to decrease psychiatrists' payment under the Medicare program by 2 percent on average. On top of the 5 percent adjustment to the conversion factor, payment for psychiatrists had been expected to drop on average by 7 percent next year (Psychiatric News, December 15, 2006).Now, because of the Congressional action, payment for psychiatrists will drop on average by just 2 percent. Many other specialties will be experiencing greater cuts in payment even after the action by Congress.(The work and practice expense RVUs are components of the Resource-Based Relative Value Scale, the elaborate formula used to calculate physician payment under the Medicare program; another component is the malpractice insurance expense RVU. To derive a payment rate for each CPT code, the three components are added together and multiplied by the conversion factor.)HR 6111 states that the measures to be used for quality reporting are those formulated for the CMS Physician Voluntary Reporting Program. Among them are measures for reporting use of antidepressant medication for a new episode of major depression.APA and AMA welcomed the congressional action, while vowing to continue advocating for a reform of what AMA has persistently called a“ flawed” Medicare physician payment formula.Nicholas Meyers, director of APA's Department of Government Relations, said, “APA joins the AMA and all of medicine in thanking the members of the 109th Congress for their success in blocking a damaging Medicare cut,” he said. “The action amounts to a significant payment shift in favor of psychiatrists and other physicians.”Meyers added, however, that “this is not a permanent correction to the underlying flawed payment formula. We will continue our work with the AMA to fix the formula once and for all so our members don't have to worry about the payment fight every year.”In a statement released after passage of the bill, AMA Board Chair Cecil Wilson, M.D., said, “Congressional action to avert next year's 5 percent Medicare physician payment cut will help avert a potential sharp decline in access for America's seniors.”With respect to quality reporting, Wilson noted that the AMA Physician Consortium for Performance Improvement, which includes representation from APA, has already developed 151 quality measures.“We will work to ensure that consortium measures continue to form the foundation of a Medicare quality reporting program,” Wilson said.“ We will work closely with the incoming Congress to address concerns with the current reporting framework.”The text of the Tax Relief and Health Care Act of 2006 is posted at<http://thomas.loc.gov/home/c109query.html>.▪ ISSUES NewArchived

Cost effectiveness of oral fludarabine in chronic lymphocytic leukaemia: the French case

SummaryThe objective was to assess the medicoeconomic impact of initial and subsequent treatments based on oral fludarabine, intravenous chemotherapy (mini-CHOP) and chlorambucil in chronic lymphocytic leukaemia.A Markov model has been defined to encompass the 18 strategies over a 3-year period after starting the first treatment. Costs of treatments, side effects and follow-up have been calculated by crossing data from published prospective trials, specific hospital databases and French resource-based relative value scales. When treatments were based on mini-CHOP, different possibilities offered for hospital care were taken into account.Probalistic sensitivity analysis was performed.Whatever the modality of hospital care for mini-CHOP, the strategies based on oral fludarabine as first-line treatment are not only more effective but are also cost effective and dominate other types of scenarios.Fludarabine given orally should be preferred to mini-CHOP or chlorambucil as a first-line treatment for patients with chronic lymphocytic leukaemia.

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.

2006 Resource-Based Relative Value Scale

The Centers for Medicare and Medicaid Services (CMS) published the 2006 Medicare Resource-Based Relative Value Scale (RBRVS) on its Web site (http://www.cms.hhs.gov) on November 2 and in the Federal Register on November 21, 2005. These relative value units (RVUs) are important because many state Medicaid programs and other third-party payers use them as a basis for their reimbursement policies.The total RVUs for a code are made up of resource-based relative values for work, practice expenses (facility and non-facility), and malpractice expenses. Medicare assigns geographic practice cost indexes (GPCIs) that reflect the relative costs associated with physician work, practice expenses, and malpractice expenses in Medicare localities compared with national average relative costs. A Medicare conversion factor (CF) is then established to allow conversion of RVUs into the payments used to reimburse physicians for Medicare services. The 2006 Medicare CF is $36.1770, a decrease of 4.5% from last year’s CF of $37.8975.Total the physician work, practice expense (facility or non-facility), and malpractice RVUs. Multiply that total by the appropriate GPCIs for your area or locality. Multiply the total adjusted RVUs by the Medicare CF.Total the physician work, practice expense (facility or non-facility), and malpractice RVUs. Multiply that total by a payer-specific or practice CF.The new Current Procedural Terminology (CPT®) codes with assigned RVUs are listed in the Table. Note that RVUs have not yet been assigned to the new codes for moderate sedation, after-hours services, and domiciliary and home care plan oversight.Remember that some payers will apply their own relative value adjustments or use their own CFs. It is important tounderstand the basis they use to determine their payment rates. The importance of understanding RBRVS cannot be overemphasized. Every practice should be aware of its costs associated with each service or procedure and be able to calculate relative values.The American Academy of Pediatrics has developed a detailed summary of RBRVS and its effect on pediatrics that includes a table of the most common RVUs for your use. You can access this information at http://www.aap.org/visit/RBRVSbrochure.pdf.You can find the complete list of RVUs and GPCIs at http://www.cms.hhs.gov/apps/pfslookup.

Current Procedural Terminology (CPT) coding for descending thoracic aorta endovascular repair

Current Procedural Terminology (CPT), developed by the American Medical Association, is the coding process used to describe surgical and diagnostic procedures and other medical services and for reporting those activities to insurance carriers for reimbursement. Within the resource-based relative value scale system, each CPT code is assigned a relative value unit for physician work, practice expense, and professional liability insurance. Payment for the work is calculated by adding the relative value units (adjusted for geographic differences) and multiplying that sum by a conversion factor expressed in dollars that is calculated each year by the Centers for Medicare and Medicaid Services (CMS). There is significant physician input in both the editorial process of developing new CPT codes and in the process of evaluating the associated work. The CPT process undergoes constant refinement: new codes are added as the medical community adopts new technologies and procedures. Endovascular repair of thoracic aortic aneurysms provides an excellent example of this process.

Surviving the Perfect Storm: An RVU-Based Model to Evaluate the Continuing Impact of MMA on the Practice of Oncology

The Resource-Based Relative Value Scale (RBRVS) system instituted by Centers for Medicare and Medicaid Services has lead to the implementation of a new financial analysis paradigm based on relative value units (RVUs). RVU-based financial tools have great potential to allow in-depth analysis of all components of the cancer care delivery system. Because all medical oncology practices must become conversant in RVU terminology and methodology, RVU-based financial tools will allow standardization and benchmarking for intra- and interpractice comparisons. Understanding this approach is essential for sound business management. The emotional and financial pressures facing the medical oncologist in private practice are enormous, with no real relief in sight. The complexity of managing the business of private practice oncology rivals that of managing the complexity of cancer care. With anticipated reductions in total net revenue per clinical treatment protocol per course of care, funds available for providers and their practices will be severely reduced. Only those practices with superlative RVU-based cost and revenue accounting systems will be able to prospectively and efficiently manage their businesses. Clearly, management of the Oncology Practice Econometric Model (OPEM) expense RVU or similar RVU-based data will be required for survival. The purpose of this article is to explore an RVU-based model to analyze the professional, infusion, and therapeutic components of contemporary cancer care.