NEJM February 28, 2018
In the past, I have argued that Medicare needed to move away from its reliance on the Resource-Based Relative Value Scale (RBRVS) and the Sustainable Growth Rate formula (SGR) for physician reimbursement if it was serious about supporting value-based health care delivery.1,2 Indeed, the RBRVS–SGR combination represented the opposite of a value-based system: reimbursement reflecting the average effort and expenses of a physician providing a given service, in a system that assumed the “collective guilt” of physicians, in that all physicians’ Medicare fee-for-service reimbursements were adjusted according to whether aggregate Medicare fee-for-service spending for physicians grew faster or slower than the overall economy.
With a level of bipartisan support that has become rare, Congress passed the Medicare Access and CHIP...
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