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Un análisis crítico de la escala de valor relativo basada en los recursos
1Department of Surgery, UCLA School of Medicine 90024-1741.
JAMA
|January 4, 1992
Resumen
Las tasas de reembolso de médicos no son sustancialmente diferentes por hora entre las especialidades médicas y quirúrgicas. La escala de valor relativo basado en recursos (RBRVS) y la tabla de tarifas de Medicare son inadecuadas para reformar el reembolso médico.
Área de la Ciencia:
- Economía de la salud Economía de la salud
- Políticas y políticas médicas.
- Reembolso de gastos médicos por el médico.
Sus antecedentes:
- Existe la percepción de que los servicios médicos de procedimiento se reembolsan a una tasa más alta que los servicios cognitivos.
- El Congreso ordenó a la Administración de Financiamiento del Cuidado de la Salud (HCFA, por sus siglas en inglés) que estableciera un calendario de tarifas de Medicare para cambiar el financiamiento de los servicios procesales a los cognitivos.
- Se desarrolló una escala de valor relativo basado en recursos (RBRVS) para proporcionar una base racional para este cambio al equiparar el valor del servicio a los recursos necesarios.
Objetivo del estudio:
- Evaluar las tasas de reembolso de los médicos utilizando un método comercial / industrial estándar (ingresos divididos por horas de trabajo).
- Para volver a calcular las tasas de reembolso bajo los sistemas de pago propuestos, incluido el calendario de tarifas de RBRVS y HCFA.
- Evaluar la adecuación de la tabla de tarifas de RBRVS y HCFA como bases para la reforma del reembolso de médicos.
Principales métodos:
- Se analizaron los ingresos y las horas de esfuerzo profesional de 15 especialidades médicas y quirúrgicas utilizando fuentes de datos independientes.
- Empleado el método comercial / industrial estándar para determinar la tasa de reembolso (ingresos / horas de trabajo).
- Utilizó los cambios de ingresos pronosticados de las tarifas de Harvard-Hsiao RBRVS y HCFA para volver a calcular las tasas de reembolso.
Principales resultados:
- Las tasas promedio de reembolso por hora para especialidades médicas (33,90 dólares) y quirúrgicas (38,80 dólares) no fueron sustancialmente diferentes.
- La diferencia en el ingreso anual entre las especialidades se explicó principalmente por las horas semanales adicionales de trabajo de los cirujanos (17,2 horas más).
- El sistema de pago RBRVS y HCFA propuesto igualaba los ingresos, pero no reconocía las horas de esfuerzo, capacitación o diferencias de trabajo.
Conclusiones:
- La tabla de tarifas de RBRVS y HCFA son bases inadecuadas para reformar el sistema de reembolso de médicos.
- La percepción de un mayor reembolso por servicios procesales probablemente se deriva de los métodos de facturación, no de las tarifas horarias reales.
- La reforma del reembolso debe considerar factores más allá de la asignación de recursos, como el esfuerzo de trabajo real y la capacitación.
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