J Korean Neurosurg Soc.  2017 Jan;60(1):47-53. 10.3340/jkns.2016.0405.003.

The Korean Spinal Neurosurgery Society ; Are We Reimbursed Properly for Spinal Neurosurgical Practices under the Korean Resource Based Relative Value Scale Service?

Affiliations
  • 1Department of Neurosurgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea. ykapa76@yahoo.co.kr

Abstract


OBJECTIVES
The Korean Resource Based Relative Value Scale (K-RBRVS) was introduced in 2001 as an alternative of the previous medical fee schedule. Unfortunately, most neurosurgeons are unfamiliar with the details of the K-RBRVS and how it affects the reimbursement rates for the surgical procedures we perform. We summarize the K-RBRVS in brief, and discuss on how the relative value (RV) of the spinal neurosurgical procedures have changed since the introduction in 2001.
METHODS
We analyzed the change of spinal procedure RVs since 2001, and compared it with the change of values in the brain neurosurgical procedures. RVs of 88 neurospinal procedures on the list of K-RBRVS were analyzed, while 24 procedures added during annual revisions were excluded.
RESULTS
During the past 15 years, RVs for spinal procedures have increased 62.8%, which is not so different with the cumulative increase of consumer prices during this time period or the increase rate of 92.3% for brain surgeries. When comparing the change of RVs in more complex procedures between spinal and brain neurosurgery, the increase rate was 125.3% and 133%, respectively.
CONCLUSION
More effort of the society of spinal surgeons seems to be needed to get adequate reimbursement, as there have been some discrimination compared to brain surgeons in the increase of RVs. And considering the relative underestimation of spinal neurosurgeons' labor, more objective measures of neurospinal surgeons' work and productivity should be developed for impartial reimbursement.

Keyword

Korean Resource Based Relative Value Scale; Relative value; Medical fee schedule; Reimbursement; Neurosurgery

MeSH Terms

Appointments and Schedules
Brain
Discrimination (Psychology)
Efficiency
Fees, Medical
Neurosurgeons
Neurosurgery*
Neurosurgical Procedures
Relative Value Scales*
Surgeons

Figure

  • Fig. 1 A schematic box of factors consisting the RV of physician’s practice. RVs of physicians’ practices are determined on the basis of resource costs required to produce services: total work (time and intensity) of the physician, practice (overhead) costs and the opportunity costs regarding possible risks of professional negligence during medical practices. RV : relative value.

  • Fig. 2 A schematic box of payment for a physician’s practice. Payment for a physician’s practice is determined by multiplying the RVs of each practice by a conversion factor, which converts the RV into Korean Won amounts. RV : relative value.

  • Fig. 3 Change of relative values of representative neurosurgical procedures during 15 years since the introduction of K-RBRVS. A : Change of relative values of tumor removal procedures. B : Change of relative values of representative brain surgeries. C : Change of relative values of representative spinal surgeries. K-RBRVS : Korean Resource Based Relative Value Scale, RV : relative value.

  • Fig. 4 Average proportion of physician’s labor, practice costs and opportunity costs for RVs under Resource Based Relative Value Scale (RBRVS) of United States (US) and Korea. In the US, the physician’s labor takes 55% of the total RV, which is much higher than that of Korean RBRVS which is 18% currently. RV : relative value.


Reference

References

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