Resource-based relative value units: a primer for academic family physicians.

The Resource-based Relative Value Scale (RBRVS) is the prevailing model used to reimburse physician services today. Based on empirical research, relative value units (RVUs) quantify the relative work, practice expense, and malpractice costs for specific physician services to appropriately establish payment. The fee schedule, implemented by the Health Care Financing Administration in 1992, dramatically affected physician reimbursement, with the goal of correcting disparities across disciplines. In the first 6 years, Medicare payments to family physicians increased by 36%, while payments to specialists decreased by as much as 18%. Recent changes include new practice expense estimates and adjustment of payment based on facility type. The impact of RVUs is even more widespread as many private payers use the fee schedule to set payment rates and as RVUs become the yardstick for physician productivity measures. Despite the initial successes, the ability of RVUs to capture the work done by primary care providers is still limited. Primary care services today are not as easily quantified as surgical procedures, and coding limitations hinder documentation of services. Rapid changes in health care make comparisons to work done 2 decades ago difficult. Understanding the strengths and limitations of RVUs as they apply to family physicians is fundamental to safeguarding the role of primary care.