Thursday, October 02, 2008

Internal Medicine

DB and I, in dealing with this topic before, have offered many descriptive attributes. But what is the essence of general Internal Medicine? A wonderful article by one of the field’s great teachers, Dr. Craig Kitchens, got me thinking: Internal Medicine is a cognitive service.

The RBRVS, which stood for Resource Based Relative Value Scale was, as originally conceived, supposed to reward cognitive service and thereby close the gap between procedural and non-procedural specialties:

We compare RBRVs with current charges and find several general patterns. Invasive procedures are typically compensated at more than double the rate of evaluation-and-management services, when both consume the same resource inputs. Imaging and laboratory procedures fall between invasive and evaluation-and-management services. We analyze the financial implications of the RBRVS by developing a simple model and simulating the effects of an RBRVS-based fee schedule on physicians' revenues in various specialties. We use Medicare data to perform the simulation under the "budget-neutral" assumption. Results show that an RBRVS-based fee schedule affects specialties differently. The average family practitioner could receive 60 percent more revenue from Medicare, whereas the average ophthalmologist could lose 40 percent of current revenues. The effects on other specialties fall between these two.

But then HCFA (now known as CMS) got ahold of the concept and as the government plan unfolded RBRVS came to be known as Real Bad Reimbursement Very Soon. Bad for everybody.

What is cognitive service? Read Kitchens’ paper. You’ll be inspired. You’ll also be frustrated when you realize that the present day distortion of RBRVS penalizes rather than rewards cognitive services. It’s just one more reason why general Internal Medicine is suffering.

2 comments:

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Mark Dave Foster said...

As far as I know, Internal medicine is divided up into several distinct and unique categories. The reason being the huge debts which they incur over the period of time, need to reimbursed from their salaries. Hence, even if the aforementioned salary might look lucrative, it plummets to a modest amount for making ends meet.