RESOURCE-BASED RELATIVE VALUE SCALES - IMPACTS AND RECOMMENDATIONS RELATIVE TO CHIROPRACTIC PRACTICE

Purpose: The American health care financing and delivery system is cha nging at a rapid pace. As part of recent reform of payment systems for physician services, Medicare has adopted a resource-based relative va lue scale (RBRVS) that is becoming a national standard. Research has n ow documented characteristics of physicians' work and the overhead for providing specific health services for most medical specialties and d isciplines. This information is being used to develop service descript ions (billing codes) and reimbursement levels. No such data exist rela tive to chiropractic, which may hinder chiropractic's efforts to be in cluded in evolving reimbursement schemes. RBRVS and its relevance to c hiropractic is reviewed, information on work levels and practice costs is discussed, chiropractic practice is reviewed and a research and po licy agenda for documenting chiropractic work, overhead and service de scriptions is provided. Methodology: A manual systematic review of ava ilable recent and relevant medical and chiropractic literature was und ertaken to characterize how the RBRVS system for reimbursement of phys ician services was developed and implemented. Payer and trade associat ion literature was used to determine what established work value and p ractice costs for DCs there are. Published payment scales from governm ental commissions were also obtained. Conclusions: Resources are urgen tly needed to survey levels of work by chiropractors in providing thei r various health services. The methodology should be the one used by t he Health Care Financing Administration to assess other specialties. A range of generic manipulation codes should be developed and tested in a similar fashion for submission for inclusion in Physician's Current Procedural Terminology (CPT). A seed range of descriptions is present ed. A systematic collection of practice overhead costs and malpractice risk should be undertaken and documented using standardized methodolo gy.