In Setting Doctors’ Medicare Fees, CMS Almost Always Accepts the Relative Value Update Panel's Advice on Work Values
Mailman School of Public Health, Columbia University, New York City, New York, USA.Health Affairs (Impact Factor: 4.97). 05/2012; 31(5):965-72. DOI: 10.1377/hlthaff.2011.0557
To calculate physicians' fees under Medicare--which in turn influence the physician fee schedules of other public and private payers--one of the essential decisions the Centers for Medicare and Medicaid Services (CMS) must make is how much physician time and effort, or work, is associated with various physician services. To make this determination, CMS relies on the recommendations of an advisory committee representing national physician organizations. Some experts on primary care who are concerned about the income gap between primary and specialty care providers have blamed the committee for increasing that gap. Our analysis of CMS's decisions on updating work values between 1994 and 2010 found that CMS agreed with 87.4 percent of the committee's recommendations, although CMS reduced recommended work values for a limited number of radiology and medical specialty services. If policy makers or physicians want to change the update process but keep the Medicare fee schedule in its current form, CMS's capacity to review changes in relative value units could be strengthened through long-term investment in the agency's ability to undertake research and analysis of issues such as how the effort and time associated with different physician services is determined, and which specialties--if any--receive higher payments than others as a result.
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ABSTRACT: Many health policy analysts envision provider payment reforms currently under development as replacements for the traditional fee-for-service payment system. Reforms include per episode bundled payment and elements of capitation, such as global payments or accountable care organizations. But even if these approaches succeed and are widely adopted, the core method of payment to many physicians for the services they provide is likely to remain fee-for-service. It is therefore critical to address the current shortcomings in the Medicare physician fee schedule, because it will affect physician incentives and will continue to play an important role in determining the payment amounts under payment reform. This article reviews how the current payment system developed and is applied, and it highlights areas that require careful review and modification to ensure the success of broader payment reform.Health Affairs 09/2012; 31(9):1977-83. DOI:10.1377/hlthaff.2012.0350 · 4.97 Impact Factor
Article: Phasing Out Fee-for-Service Payment[Show abstract] [Hide abstract]
ABSTRACT: In March 2012, the Society of General Internal Medicine convened the National Commission on Physician Payment Reform to recommend forms of payment that would maximize good clinical outcomes, enhance patient and physician satisfaction and autonomy, and provide cost-effective care. The formation of the commission was spurred by the recognition that the level of spending on health care in the United States is unsustainable, that the return on investment is poor, and that the way physicians are paid drives high medical expenditures. The commission began by examining factors driving the high level of expenditures in the U.S. health care system. It . . .New England Journal of Medicine 03/2013; 368(21). DOI:10.1056/NEJMsb1302322 · 55.87 Impact Factor
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ABSTRACT: ABSTRACT The Resource-Based Relative Value Scale (RBRVS) is fundamentally undermined by foundational errors: (1) the full range of office-based evaluation and management (E/M) activities are not captured by the current CPT code choices, (2) RBRVS places relatively high values on procedural services, (3) there is no measure of intensity for complex outpatient E/M care, (4) maintaining and updating RBRVS has been delegated to select professional societies. Limitations imposed on the development of RBRVS dating to the early 1980s have not been corrected. The repertoire of codes for physician office-based E/M work must be expanded to create a new "topology" of choices with new outpatient code families with discrete service code levels, such as comprehensive outpatient consultation care, comprehensive outpatient primary care, and limited outpatient consultation care. Service code relative values must be based on representative samples and reliable survey data, draw from the broader literature on work intensity, and developed with accountable and representative professional engagement.Chest 06/2013; 144(3). DOI:10.1378/chest.13-0381 · 7.48 Impact Factor
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