Understanding and applying a resource-based relative value system to your neurosurgical practice.

The payment policy for United States physicians was formerly based on determination of customary and prevailing charges from their fee schedules. Rapidly growing health care expenditures in the 1980s led to a fundamental change in payment reimbursement in which the new system was based on the resource costs to the physician for providing health care services. This reform highlights the significant regulatory morass that has come to burden the health care industry. One of the most critical changes in physician reimbursement was caused by the Congressional mandate that led to the development of a resource-based relative value scale (RBRVS) for the creation of the Medicare physician fee schedule. Most physicians, however, have limited familiarity with the RBRVS system, which now serves as the basis for Medicare-related physician reimbursement as well as many third-party payers. A historical review of the development of the RBRVS will serve as the basis for applying the methodology to improve the effectiveness of the neurosurgeon's practice.