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Despite many fees for medical services being dramatically reduced over time, health expense as a proportion of GDP has steadily risen over the past 50 years. Payment for cognitive efforts now lags dramatically behind payment for procedural efforts. Our nation has focused on the amounts paid for ICD9 or CPT4 codes, rather than on the quality of medical decisions made by caregivers and their patients. Surgical specialties have been more successful lobbying for higher payment than cognitive specialties. Yet, it is just this sum of medical procedures that reflects clinical decisions for an individual over time that determines individual healthcare costs and, in turn, the nation�s healthcare costs. Therefore, fees should be based on physician-patient comparative efficacy rather than unit costs. Hsiao�s RBRVS should be implemented to overcome inappropriate disparities in physician payment and be augmented by comparative efficacy for primary care cognitive services.
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