LECTURE+9+-+Physician+services

LECTURE+9+-+Physician+services - Lecture 9: Physician...

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Lecture 9: Physician Services Health Economics 01:220:316 Prof. Derek DeLia, Ph.D.
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Physician organization Specialists Body systems Procedures Generalists ( primary care ) General wellness Early diagnosis Coordination, prevention, follow-up Social/behavioral issues Economic issues Reimbursement Quality/value Doctor-hospital relations
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Physician Reimbursement
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Physician reimbursement Early 20 th C No insurance ==> patient fees Free market regulated market High tech medicine ==> expensive 1920’s-50’s Third party insurance ↑ Cost-based FFS 1950’s-60’s Blue Cross/Blue Shield (others later) Relative value units (RVU’s)
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Relative value units Standardized relative values Base procedure: RV = 1.0 Complex procedures: RV > 1.0 Simple procedures: RV < 1.0 What about non-procedures? Conversion factors Payment = RV*CV CV’s negotiated w/insurers Historical benchmarks Prior insurance ==> procedure RV’s inflated PC services competitively priced CV updates ==> ↑ spread between PC & specialty care
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Medicare physician reimbursement Medicare, 1965 Largest single insurer Sets standard for other payers Originally paid cost-based FFS Resource-based relative value scale (RBRVS), 1992 RVU’s Conversion factors Special adjustments Evaluation and management Historical biases against PC
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30 minutes of physician time Source: Sandy et al., 2009
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Payment updates under Medicare RBRVS Budget/legislative priorities New services/technologies Procedure costs often ↓ Standardization Orderly scheduling Not standardized Visits unpredictable (timing, content, length) Complex chronic illness ↑
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Relative Value Update Committee Goal: make appropriate updates to RVU’s as needed Growing concern ==> goal not met Medical society reps Dominated by specialists PC not well represented Value of procedures emphasized Productivity ↑ not well reflected Complexity ↑ not well adjusted
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This note was uploaded on 11/20/2011 for the course ECONOMICS 220:316 taught by Professor Delia during the Spring '11 term at Rutgers.

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LECTURE+9+-+Physician+services - Lecture 9: Physician...

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