PANEL PROCESSES FOR REVISING RELATIVE VALUES OF PHYSICIAN WORK - A PILOT-STUDY

In this study, a set of meetings was conducted to pilot a group-discus sion-based method anchored by a reference set of services with agreed- on values for revising the Medicare Resource-Based Relative Value Scal e (RBRVS). The authors focused on the method as it evolved over the se quence of meetings, rather than on whether the relative values of work obtained were more or less valid than relative values of work obtaine d elsewhere. Four pilot panels, composed of 46 physicians from differe nt specialties (including primary care), were conducted to rate total physician work. One panel examined 80 urologic services, another panel examined 80 ophthalmologic services, and the last two panels consider ed the merit of appeals from five specialty and subspecialty societies to 68 and 48 services, respectively. Rather than using the method of ratio estimation relative to a standard service, panelists were asked to estimate magnitudes relative to an established multispecialty refer ence set of values. Prominent members of that reference set were graph ically displayed to panelists on a ''ruler.'' Measures included physic ians' preliminary and final ratings and detailed notes of the group di scussions conducted between the ratings. The authors found that a pane l process for refining relative values of work is practical, provided that panelists are provided with a valid reference set for comparison purposes and provided that care is taken that all members feel comfort able engaging in the discussion. In Summer 1992, the Health Care Finan cing Association conducted a series of multispecialty panels based on the methods presented here to produce the 1993 RBRVS; in addition, the RBRVS Update Committee of the American Medical Association is employi ng group processes and a reference set in determining the relative wor k values of new Current Procedural Terminology codes.