To the Editor. —
The determination by Hsiao et al1 of the resource-based relative value (RBRV) of a given medical service can be summarized as:RBRV = (TW)(1 + RPC)(1 + AST) where TW is the total work input by the physician, RPC is an index of relative specialty practice costs, and AST is an index of amortized value for the opportunity cost of specialty training.Logically, one would assume that, on the whole, the RPC factors for a given specialty should reflect the cost of providing the work of that specialty, in the same way that TW represents the work provided by that specialty. Instead, Hsiao et al have built their scheme on an RPC factor that represents the cost of generating a given amount of revenue in 1983. A problem arises in that an RPC based on the fraction of 1983 gross revenues will be meaningless and inapplicable
Bodoia R. The Resource-Based Relative Value Scale. JAMA. 1989;261(16):2327–2328. doi:10.1001/jama.1989.03420160051013
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