Chest

With reference to my recentCHESTarticle,1Laugesen MJ The Resource-Based Relative Value Scale and physician reimbursement policy.Chest. 2014; 146: 1413-1419Abstract Full Text Full Text PDF PubMed Scopus (24) Google Scholar as well as the prior work of Kumetz and Goodson2Kumetz EA Goodson JD The undervaluation of evaluation and management professional services: the lasting impact of Current Procedural Terminology code deficiencies on physician payment.Chest. 2013; 144: 740-745Abstract Full Text Full Text PDF PubMed Scopus (18) Google Scholar in this journal, Dr Mathers asks whether relativity between cognitive and procedural service reimbursement in the Resource-Based Relative Value Scale (RBRVS) is feasible. Existing evidence points to persistent differences in cognitive and procedural service reimbursement.3Maxwell S Zuckerman S Berenson RA Use of physicians' services under Medicare's resource-based payments.N Engl J Med. 2007; 356: 1853-1861Crossref PubMed Scopus (45) Google Scholar, 4Sinsky CA Dugdale DC Medicare payment for cognitive vs procedural care: minding the gap.JAMA Intern Med. 2013; 173: 1733-1737PubMed Google Scholar Reimbursement for cognitive services should reflect the work associated with providing the service. One problem is that certain structural features of the RBRVS constrain and may contribute to undervaluation. Physicians providing cognitive services have a smaller bandwidth of billable codes; their billing is also more heavily scrutinized due to documentation requirements. The cut points are less precise for many cognitive services: Surgical and procedural services often appear to be more precisely distinguished. These gradations make a difference for physicians providing cognitive services—but especially if they are already operating at the margin of the work time and intensity involved. In the case of evaluation and management services, for example, the Relative Value Scale Update Committee time estimates used by the Centers for Medicare & Medicaid Services are closer to independently m...

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