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June 3, 1992

A Critical Analysis of RBRVS-Reply

Author Affiliations

UCLA Medical Center Los Angeles, Calif

JAMA. 1992;267(21):2896. doi:10.1001/jama.1992.03480210051031

In Reply.  —Each of the letters makes, in different ways, two points. First, physicians are uncomfortable with the implications of using reimbursement rates per hour for different putative skill levels—I agree. The lawyers were also uneasy until the Supreme Court (Goldfarb vs Fairfax County Bar Association) found that fee schedules in the learned professions violated antitrust law. My lawyer has since charged for time to the nearest 0.1 hour at rates varying from $150 per hour for junior associates to $300 for senior partners. The second is that the data of others used in the study are poor. I agree that the Mendenhall study (the only available) was elegantly done, but it is 15 years old. The HCFA spent $100 million in 3 months to revise the computer software used by regional medicare carriers to implement the latest fee schedule. Could not $250 000 be spent to learn if the