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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
PubMed
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.

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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.

Related Experiment Videos

  • 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.