Medicare's resource-based relative value scale fee schedule portends a gloomy future for trauma surgery.

Medicare's resource-based relative value scale (RBRVS) fee schedule dramatically restructures physician reimbursement; providers of cognitive-based services are projected to gain at the expense of those with procedure-based services. In this study, we computed the impact of the new payment system for Medicare comparing trauma surgery to four other surgical specialties. Plastic surgery will see a 4% increase in revenue, but the other specialties will experience a cut (trauma, minus 14%; general, minus 4%; vascular, minus 5%; cardiothoracic, minus 10%). As expected, with the exception of plastic surgery, there was a decrease in procedure reimbursement (trauma, minus 13%; general, minus 12%; vascular, minus 8%; cardiothoracic, minus 10%). However, when analyzing cognitive services, trauma is the only group that will sustain a reduction. This is largely explained by the fact that trauma cognitive services are inpatient based, whereas the RBRVS fee schedule is biased toward outpatient cognitive services. In conclusion, the RBRVS fee schedule will challenge the economic stability of trauma surgeons. Because Medicare reform will set future standards for other forms of physician reimbursement, trauma system planners need to take a proactive role in this evolving process.