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Growth in Medicare inpatient physician charges per admission, 1986-1989
1Health Policy Center, Urban Institute, Washington, DC 20037.
Abstract:
Recently, there has been increasing interest in alternative Volume Performance Standards centered around the hospital medical staff. Using a national sample of Medicare claims, this paper analyzes growth in Medicare inpatient physician charges per admission between 1986 and 1989, by specialty, type of service, and type of hospital. Although growing more slowly than outpatient services, inpatient physician service volume and intensity growth is substantial. Inpatient physician services grew at an annual rate of 8.3%-31% of which was attributable to prices, 27% to case mix, and 41% to volume and intensity. Services provided by cardiologists, gastroenterologists, and other medical specialists demonstrate annual volume and intensity increases exceeding 13% annually. Consultations, hospital visits, and specialist services account for a third of all services provided during the admission and also demonstrate rapid annual rates of growth.
Insights
Inpatient physician charges grew significantly from 1986-1989, driven by volume and intensity, especially for specialists like cardiologists. This highlights substantial growth in physician services during hospital admissions.
Area of Science:
- Health Economics
- Medical Services Research
- Physician Billing Analysis
Background:
- Increasing focus on alternative Volume Performance Standards for hospital medical staff.
- Need to understand trends in inpatient physician charges and service utilization.
Purpose of the Study:
- To analyze the growth of Medicare inpatient physician charges per admission between 1986 and 1989.
- To examine growth by medical specialty, service type, and hospital type.
Main Methods:
- Analysis of a national sample of Medicare claims data.
- Examination of inpatient physician charges, volume, and intensity trends.
- Stratification by specialty, service type, and hospital characteristics.
Main Results:
- Inpatient physician services experienced substantial growth, with annual rates of 8.3%.
- Price increases accounted for 31%, case mix for 27%, and volume/intensity for 41% of growth.
- Cardiology, gastroenterology, and other medical specialties showed annual volume/intensity increases over 13%.
- Consultations, hospital visits, and specialist services comprised one-third of all services and grew rapidly.
Conclusions:
- Significant growth in inpatient physician service volume and intensity occurred between 1986 and 1989.
- Medical specialists, particularly cardiologists and gastroenterologists, drove much of this growth.
- Understanding these trends is crucial for developing effective Volume Performance Standards.