The Resource-based Relative Value Scale (RBRVS) was established in 1992 to bring standardization and predictability across the country for Medicare payments. This transition resulted in a 29% decrease in Medicare payment for anesthesia services from the 1991 rate. The preliminary efforts to address this issue indicated that Medicare rates were approximately 33% of commercial rates and the matter became known as “The 33% Problem.” The disparity between Medicare's undervaluation of anesthesia care and commercial payer rates has steadily increased during the intervening years, illustrating the unsustainable nature of the problem.

When Hsiao et al developed the RBRVS, anesthesia services did not receive the same level of review as other medical services and procedures. Hsiao's work relied heavily on cross-specialty comparisons where services performed by one specialty were compared with services provided by other specialties. In most instances, 12-15...

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