Related Experiment Videos
Physician payment reform: anesthesiology as a case study
D A Revicki1, F K Orkin, B R Luce
1Medical Technology and Policy Research Center, Battelle Human Affairs Research Centers, Washington, DC 20024.
Anesthesiology
|October 1, 1990
Summary
Simulating physician payment reforms, Resource-based Relative Value Scale (RBRVS) and physician diagnosis-related groups (MDDRG) showed varied anesthesiology payments. Equitable payment requires retaining a time factor, as longer surgeries led to payment decreases.
Area of Science:
- Health Economics
- Medical Policy
- Anesthesiology
Background:
- Physician payment reform is crucial for equitable healthcare delivery.
- Current anesthesiology payment models may not accurately reflect service complexity and duration.
- Simulating alternative payment systems is essential to evaluate their impact.
Purpose of the Study:
- To simulate and compare anesthesiology payments under Resource-based Relative Value Scale (RBRVS) and physician diagnosis-related groups (MDDRG) payment reforms.
- To assess the impact of these reforms on anesthesiologists across different practice settings.
- To determine the importance of a time factor in anesthesiology payment methodologies.
Main Methods:
- Merged Medicare Part A and Part B payment data for 7,770 patients and 10,431 surgical procedures.
- Simulated RBRVS and MDDRG payments under budget neutrality, comparing them to current payment systems.
- Analyzed data from 16 hospitals across diverse geographic regions, bed sizes, and teaching statuses.
Main Results:
- Simulated RBRVS and MDDRG systems showed systematic payment variations compared to the current system.
- Anesthesiologists in rural and non-teaching hospitals were projected to gain, while those in urban/suburban and teaching facilities were projected to lose.
- Payment gains/losses were influenced by surgery duration, not anesthesiologist-driven complexity, with longer cases resulting in decreased payments.
Conclusions:
- The duration of surgery significantly impacts anesthesiology payments under simulated RBRVS and MDDRG systems.
- Equitable payment distribution across practice settings is challenged by these reforms without a time factor.
- Retaining a time factor in anesthesiology payment methodology is vital for achieving equitable reimbursement and supporting physician payment reform objectives.