title: Pilot study comparing patients' valuation of health-care services with Medicare's relative value units.
abstract: OBJECTIVE
  Physician reimbursement for services and thus income are largely determined by the Medicare Resource-Based Relative Value Scale. Patients' assessment of the value of physician services has never been considered in the calculation. This study sought to compare patients' valuation of health-care services to Medicare's relative value unit (RVU) assessments and to discover patients' perceptions about the relative differences in incomes across physician specialties.
  
  
  METHODS
  Cross-sectional survey.
  
  
  METHODS
  Individuals in select outpatient waiting areas at Johns Hopkins Bayview Medical Center.
  
  
  METHODS
  Data collection included the use of a visual analog 'value scale' wherein participants assigned value to 10 specific physician-dependent health-care services. Informants were also asked to estimate the annualized incomes of physicians in specialties related to the above-mentioned services. Comparisons of (i) the 'patient valuation RVUs' with actual Medicare RVUs, and (ii) patients' estimations of physician income with actual income were explored using t-tests.
  
  
  RESULTS
  Of the 206 eligible individuals, 186 (90%) agreed to participate. Participants assigned a significantly higher mean value to 7 of the 10 services compared with Medicare RVUs (P<0.001) and the range in values assigned by participants was much smaller than Medicare's (a factor of 2 vs. 22). With the exception of primary care, respondents estimated that physicians earn significantly less than their actual income (all P<0.001) and the differential across specialties was thought to be much smaller (estimate: $88,225, actual: $146,769).
  
  
  CONCLUSIONS
  In this pilot study, patients' estimations of the value health-care services were markedly different from the Medicare RVU system. Mechanisms for incorporating patients' valuation of services rendered by physicians may be warranted.
authors.affiliation: Division of General Internal Medicine, Department of Medicine, John Hopkins Bayview Medical Center, John Hopkins University School of Medicine, Baltimore, MD 21224, USA. skravet@jhmi.edu
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Kravet
authors.forename: Heather
authors.initials: H
authors.lastname: Jones
authors.forename: Eric E
authors.initials: EE
authors.lastname: Howell
authors.forename: Scott M
authors.initials: SM
authors.lastname: Wright
mesh_terms: D000328:Adult; D000368:Aged; D015142:Baltimore; D003430:Cross-Sectional Studies; D004470:Economics, Medical; D005260:Female; D017721:Hospital Costs; D006785:Hospitals, University; D006801:Humans; D008297:Male; D008494:Medical Office Buildings; D016345:Medicare Part B / Q000191:economics* / Q000592:standards*; D008511:Medicine / Q000592:standards*; D008875:Middle Aged; D017059:Models, Econometric; D010044:Outpatient Clinics, Hospital / Q000191:economics* / Q000592:standards*; D010147:Pain Measurement; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D010865:Pilot Projects; D011787:Quality of Health Care; D015895:Relative Value Scales; D013038:Specialization; D014481:United States; D055815:Young Adult