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June 3, 1992

A Critical Analysis of RBRVS

Author Affiliations

Raleigh (NC) Family Physicians, Inc

JAMA. 1992;267(21):2894. doi:10.1001/jama.1992.03480210051024

To the Editor  —As my grandfather used to say, "liars figure and figures lie." Though I wish to impune neither JAMA nor Dr Maloney, I question his analytic assumptions and conclusions1 based on data reported in Medical Economics.2 Although Maloney himself equivocates regarding "the small sample size, incomplete coverage of specialties and the use of external data sources," his conclusions fail to reflect the issues of most concern to those who have considered both the problem and the solution.Crane's data3 concerning work hours are simply not credible. An example: a family physician in 10 minutes of careful history-taking and examination makes the diagnosis of acute appendicitis. This encounter is reimbursed at the rate of $50. This physician's overhead is 50%. The patient is then referred to a general surgeon who removes the appendix and is paid $500 with no overhead. Therefore, the family physician would have