Revenue-based cost assignment: A potent but hidden threat to the survival of the multispecialty medical practice

Academic Medicine

Volumn 85, Issue 3, 2010, Pages 538-547

  Cooper, Robin ^a   Kramer, Theresa R ^b,c  

^a EMORY UNIVERSITY   (United States)

^b SOUTHERN ARIZONA VA HEALTH CARE SYSTEM   (United States)

^c UNIVERSITY OF ARIZONA   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

EID: 77649197113     PISSN: 10402446     EISSN: None     Source Type: Journal    
DOI: 10.1097/ACM.0b013e3181cd4cf7     Document Type: Article

References (42)

1. Committee on Quality of Health Care in America. To Err Is Human: Building a Safer Health System. Washington, DC: National Academy Press; 2000.
2. Institute of Medicine. America's Health Care Safety Net: Intact but Endangered. Washington, DC: National Academy Press; 2000.
3. Institute of Medicine. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, DC: National Academy Press; 2001.
4. Bodenheimer T. Coordinating care-A perilous journey through the health care system. N Engl J Med. 2008;358:1064-1071.
5. Iglehart JK. Support for academic medical centers-Revisiting the 1997 Balanced Budget Act. N Engl J Med. 1999;341:299-304.
6. Bodenheimer T. Primary care-Will it survive? N Engl J Med. 2006;355:861-864.
7. Coleman EA, Smith JD, Raha D, Min S-J. Posthospital medication discrepancies: Prevalence and contributing factors. Arch Intern Med. 2005;165:1842-1847.
8. Coleman EA, Parry C, Chalmers S, Min S-J. The care transitions intervention: Results of a randomized controlled trial. Arch Intern Med. 2006;166:1822-1828.
9. Goldman L. The academic health care system: Preserving the mission as the paradigm shifts. JAMA. 1995;273:1549-1552.
10. Blumenthal D, Campbell EG, Weissman JS. The social missions of academic health centers. N Engl J Med. 1997;337:1550-1553.
11. Bodenheimer T, Berenson RA, Rudolf P. The primary care-specialty income gap: Why it matters. Ann Intern Med. 2007;146:301-306.
12. Bodenheimer T, Berenson RA, Rudolf P. The primary care-specialty group gap. Ann Intern Med. 2007;146:896.
13. Blumenthal D. Toil and trouble? Growing the physician supply. Health Aff (Millwood). 2003;22:85-87.
14. Blumenthal D. New steam from an old cauldron-The physician-supply debate. N Engl J Med. 2004;350:1780-1787.
15. Fuhrmans V. Hard case: Medical specialties hit by a growing pay gap-Shortages develop in endocrinology, pediatric fields. Wall Street Journal. May 5, 2008:1. Available at: http://online.wsj.com/article/SB120995022062766515. html?mod-googlewsj. Accessed May 21, 2008.
16. Frohman LP. The human resource crisis in neuro-ophthalmology. J Neuroophthalmol. 2008;28:231-234.
17. Cunningham PJ, Felland LE. Falling Behind: Americans' Access to Medicare Care Deteriorates, 2003-2007. Results From the Community Tracking Study. Tracking Report No. 19. Washington, DC: Center for Studying Health System Change; 2008.
18. Thorpe KE, Shields A, Gold H, Altman S, Shactman D. Anticipating the number of uninsured Americans and the demand for uncompensated care: The combined impact of proposed Medicaid reductions and erosion of employer-sponsored insurance. Paper presented at: Council on the Economic Impact of Health Care Reform; November 8, 1995; Washington, DC. Available at: http://council.brandeis.edu/pubs/comb.pdf. Accessed January 21, 2009.
19. Cohen JJ. Transforming the size and composition of the physician work force to meet the demands of health care reform. N Engl J Med. 1993;329:1810-1812.
20. Rosenblatt RA. A view from the periphery-Health care in rural America. N Engl J Med. 2004;351:1049-1051.
21. Newton DA, Grayson MS, Thompson LF. The variable influence of lifestyle and income of medical student career specialty choices: Data from two US medical schools, 1998-2004. Acad Med. 2005;80:809-814.
22. Iglehart JK. Rapid changes for academic medical centers-Second of two parts. N Engl J Med. 1995;332:407-412.
23. Kassirer JP. Academic medical centers under siege. N Engl J Med. 1994;331:1370-1371.
24. Kuttner R. Managed care and medical education. N Engl JMed. 1999;341:1092-1096.
25. Michels R. Medical education and managed care. N Engl J Med. 1999;340:959-961.
26. Cooper R, Kramer TR. RBRVS costing: The inaccurate wolf in expensive sheep's clothing. J Health Care Finance. 2008;34:6-18.
27. Cooper R, Kramer TR. Revenue-based cost assignment: The hidden and inaccurate equal-profit-margin assumption. MGMA Connex. 2008;8:44-47.
28. Hsiao WC, Dunn DL, Verrilli DK. Assessing the implementation of physician-payment reform. N Engl J Med. 1993;328:928-933.
29. American Medical Association. RBRVS: Resource-Based Relative Value Scale. Available at: http://www.ama-assn.org/go/rbrvs. Accessed August 24, 2006.
30. Medicare program; prospective payment for Medicare inpatient hospital services-HCFA. Fed Regist. 1984;49:234-334.
31. Ginsburg PB, Berenson RA. Revising Medicare's physician fee schedule-Much activity, little change. N Engl J Med. 2007; 356:1201-1203.
32. Hackbarth GM. Comments on CMS's proposed rule, entitled "Medicare program; five-year review of work relative value units under the physician fee schedule and proposed changes to the practice expense methodology. Available at: http://www.medpac.gov/publications/other- reports/Aug06-MedPAC-PracticeExpense- RVU- Comment.pdf. Accessed December 12, 2008.
33. Health Care Financing Administration, Department of Health and Human Services. Medicare program; five-year review of work relative value units under the physician fee schedule. Fed Regist. 1996;61:19992-20067.
34. Health Care Financing Administration, Department of Health and Human Services. Medicare program; five-year review of work relative value units under the physician fee schedule. Fed Regist. 1999;64.
35. Health Care Financing Administration, Department of Health and Human Services. Medicare program; five-year review of work relative value units under the physician fee schedule. Fed Regist. 2001;66:31028-31084.
36. McCall NT, Cromwell J, Griggs ML. Five Year Review of Work Relative Value Units: Final Report. Waltham, Mass: Health Economics Research; 1999.
37. Trapp D. U.S. health spending tops $2.2 trillion: A Medicare pay freeze and imaging fee cuts in 2007 helped constrain the rise in spending on physician services. Available at: http://www.ama-assn.org/amednews/2009/01/19/ gvl10119.html. Accessed April 4, 2009.
38. Berenson R. Interactions between the SGR and RBRVS: Making sense of alphabet soup. Available at: http://healthaffairs.org/blog/2008/02/13/ interactions-between-the-sgrand-rbrvs-making-sense-of-alphabet-soup. Accessed June 9, 2008.
39. Druss BG, Marcus SC, Olfson M, Tanielian T, Pincus HA. Trends in care by nonphysician clinicians in the United States. N Engl J Med. 2007;348:130-137.
40. Bohmer R. The rise of in-store clinics-Threat or opportunity?NEngl J Med. 2007;356:765-768.
41. Centers for Medicare & Medicaid Services, Department of Health and Human Services. Medicare program; revisions to payment policies under the physician fee schedule, and other Part B payment policies for CY 2008; Revisions to the payment policies of ambulance services under the ambulance fee schedule for CY 2008; and the amendment of the e-prescribing exemption for computergenerated facsimile transmissions. Available at: http://www.cms.hhs.gov/ physicianfeesched/downloads/CMS-1385-FC.pdf. Accessed August 15, 2008.
42. Ginsburg PB, Grossman JM. When the price isn't right: How inadvertent payment incentives drive medical care. Health Aff (Millwood). 2005;(suppl Web exclusives): W5-376-384. Available at: http://content. healthaffairs.org/cgi/ reprint/hlthaff.w5.376v1. 41. Accessed January 14, 2009.