Connecticut recently joined a growing list of states that use Medicare Resource Based Relative Value Scales (RBRVS) for setting medical fees in workers' compensation cases. [Conn. Gen. Stat. § 31-280] If experience with other states is of any value in predicting the future, workers in Connecticut may soon find it difficult to find doctors willing to treat them. This article, written by Stephen C. Embry, examines the Connecticut experiment with RBRVS and warns that Connecticut may have adopted a failed strategy that may drive up the cost of providing care while reducing payments for care. He points out that the stated intention of the Connecticut legislation was not to reduce medical costs, but to simplify the billing process. In the past the Connecticut fee schedule has been based on reasonable and customary charges, which were regularly adjusted based on economic changes in the medical market. New procedures were added as needed. This presented a challenge to the Workers' Compensation Commission that was charged with collecting and analyzing changes in rapidly evolving fields. The driving force for adoption of RBRVS in Connecticut seems to have been more a practical desire to find an off-the-shelf and comprehensive system for categorizing or coding health care procedures for billing purposes, rather than explicit cost controls. The legislation requires that the new fee schedule be revenue neutral. Nevertheless, the adoption of the Medicare coding system is fraught with potential dangers, arising from structural imperatives and unintended consequences.

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