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April 28, 1989

The Resource-Based Relative Value Scale

Author Affiliations

Boswell, Pa

Boswell, Pa

JAMA. 1989;261(16):2328. doi:10.1001/jama.1989.03420160051014

To the Editor.—  Hsiao and associates1 calculate the "ratio of Medicare mean charge to resource-based relative values" in their article. Fairness seems to suggest that Medicare maximum allowable actual charges be recalculated to more closely conform to the reasonable goal that all physicians, regardless of specialty choices, be paid on a comparable scale. The predicted shortage of family physicians in a world of a predicted "glut" of physicians in general could then probably be avoided, and patients better served.Several editorials2-4 comment on that matter, and especially on the "budget neutrality," which is of such interest to Congress. In the discussions on the matter of converting resource-based relative values into a fee schedule, one element seems not to be given the attention it deserves. Medicare does not "set" fees, physicians do. Medicare determines a schedule of maximum allowable charges, and physicians must decide if they can or cannot