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December 16, 1992

RBRVS Gets an Eye Test-Reply

Author Affiliations

Harvard University Cambridge, Mass

JAMA. 1992;268(23):3313. doi:10.1001/jama.1992.03490230043013

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In Reply.  —Dr Tennant's letter contains erroneous reasoning, half-truths, and unsubstantiated charges. They have to be answered. The RBRVS is based on the resource costs required to perform each service. He states that a "fair" test for the RBRVS is whether it produces fees higher than the discounted charges that Medicaid and HMOs pay to physicians. His test is not valid. If a charge for a service is much higher than the resource costs involved, then a discount on that charge would not necessarily produce a charge lower than resource costs.Tennant offers a half-truth when he states that we erred in our initial determination of the ophthalmological RBRVS and that we would only restudy them when the AAO had paid us $250 000. This is not the case. The AAO challenged our original findings on the grounds that some ophthalmological services were highly specialized and most general ophthalmologists sampled