A consensus process to determine the relative complexity-severity of frequently performed surgical services.

Current prevailing fees represent initial charges inflated over time, and it is well known that some services, such as surgical treatment of the coronary arteries, are less demanding services today than in the early days of the specialty, when morbidity, mortality and operative stress were extremely high. Resource costs are difficult to measure accurately and time is an inappropriate indicator of complexity and severity. If society is looking for ways in which physicians will support changes in reimbursement, the C-S index resulting from the consensus process which has been described herein could provide an acceptable basis for a variety of payers to assess services. We plan to validate this consensus method in other geographic areas and will report the results in appropriate publications. We hope that the C-S index will be valuable in future policy discussions about the basis for physician fees, as well as for other health policy purposes.