Centennial reprint: 1988 report served as basis for the Medicare payment system

To help commemorate the American College of Surgeons’ (ACS) Centennial, the Bulletin is reprinting articles centered on the issues and developments that have defined the character of the organization and the surgical profession for the last 100 years. This month’s reprint from January 1989 looks at the development and implications of what was then known as the Harvard RBRVS. Perhaps no initiative has so profoundly affected the way physicians are compensated for the services they provide than the creation of the resource-based relative value scale (RBRVS).

The RBRVS was first proposed in September 1988 by William Hsaio, PhD, a Harvard University economist, and his colleagues at the Boston, MA, institution. It was implemented in 1992 under the Omnibus Budget Reconciliation Act of 1989. Since then, the RBRVS has served as the basis for the Medicare physician fee schedule.

This month’s reprint reviews initial stakeholder reactions to the report, including those of members of Congress; explores the key issues that were unresolved at the time of the report’s release; and considers how the study might have been used to develop payment policies in the future. The author concludes the article by stating, “In the end, however, it will be political and budgetary pressures that will help shape a revised Medicare physician payment policy.” These words hold true today, as policymakers debate how best to reform the Medicare physician payment system.

Download “The Harvard RBRVS: Where is it going?” from the January 1989 ACS Bulletin, Volume 74 No. 1

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