Missing productivity gains in the medicare physician fee schedule: Where are they?

Medical Care Research and Review

Volumn 67, Issue 6, 2010, Pages 676-693

  Cromwell, Jerry ^a   McCall, Nancy ^a   Dalton, Kathleen ^a   Braun, Peter ^a  

^a RTI INTERNATIONAL   (United States)

Author keywords

Medicare fee schedule; Medicare payment reform; physician productivity

Indexed keywords

ARTICLE; FOLLOW UP; HEALTH CARE COST; HUMAN; JOB PERFORMANCE; MEDICAL FEE; MEDICAL SPECIALIST; MEDICARE; OPERATING ROOM; OPERATION DURATION; POSTOPERATIVE PERIOD; PRODUCTIVITY; SELF REPORT; SURGEON; WORKING TIME;

EFFICIENCY; FEE SCHEDULES; HUMANS; MEDICARE; OFFICE VISITS; OPERATING ROOMS; PHYSICIANS; RELATIVE VALUE SCALES; TIME FACTORS; UNITED STATES; WORKLOAD;

EID: 78650215335     PISSN: 10775587     EISSN: 15526801     Source Type: Journal    
DOI: 10.1177/1077558710371115     Document Type: Article

References (54)

1. American Medical Association. (1994). Current procedure terminology (CPT) coding manual. Chicago, IL: AMA Press.
2. American Medical Association. (1999). RVS update process. Chicago, IL: Author.
3. American Medical Association. (Annual). Current procedure terminology (CPT) coding manual. Chicago, IL: AMA Press.
4. Blumenthal, D., Causino, N., Chang, Y.C., Culpepper, L., Marder, W., Saglam, D.,.. Starfield, B. (1999). The duration of ambulatory visits to physicians. Journal of Family Practice, 48, 264-271.
5. Braun, P., Dernburg, J., Dunn, D.L., & Cohen, W. (1992). Predicting the work of evaluation and management services. Medical Care, 30 (Suppl. 11), NS13 - NS27.
6. Braun, P., Hsiao, W.C., Becker, E.R., & DeNicola, M. (1988). Evaluation and management services in the Resource-Based Relative Value Scale. Journal of the American Medical Association, 260, 2409-2417.
7. Braun, P., Yntema, D., Dunn, D., DeNicola, M., Ketcham, T., & Verrilli, D. (1988). Cross-specialty linkage of resource-based relative value scales: Linking specialties by services and procedures of equal work. Journal of the American Medical Association, 260, 2390-2396.
8. Catlin, A., Cowan, C., Hartman, M., & Heffler, S. (2008). National health spending in 2006: A year of change for prescription drugs. Health Affairs (Millwood). 27, 14-29.
9. Centers for Disease Control and Prevention. (2002-2003). National ambulatory medical care surveys. Atlanta, GA: Author.
10. Centers for Medicare & Medicaid Services. (2001-2005). TIMEDATA file. Baltimore, MD: Author.
11. Cromwell, J., Hoover, S., McCall, N., & Braun, P. (2006). Validating CPT typical times for Medicare office evaluation and management (E/M) services. Medical Care Research and Review, 63, 236-255.
12. Cromwell, J., McCall, N., Hoover, S., Urato, C., & Braun, P. (2007). Assessment of the potential impact of productivity changes on Medicare RVUs: Final report (Report to the Assistant Secretary for Planning and Evaluation, DHHS, Contract No. 100-03-0018, TO HHSP0000IT). Research Triangle Park, NC: Research Triangle Institute.
13. Cromwell, J., Mitchell, J.B., & Stason, W.B. (1990). Learning by doing in CABG surgery. Medical Care, 28, 6-18.
14. Crowe, B., & Hailey, D. (2002). Cardiac picture archiving and communication systems and telecardiology-Technologies awaiting adoption. Journal of Telemedicine and Telecare, 8 (Suppl. 3). 9-11.
15. DJ Sullivan and Associates. (2001-2005). Operating room logs. Ann Arbor, MI: Author.
16. Dunn, D.L., & Latimer, E. (1996, April). Derivation of relative values for practice expenses using extant data (Report to the Health Care Financing Administration, Contract No. 500-92-0023). Cambridge, MA: Harvard School of Public Health.
17. Etheridge, L., & Dobson A. (1988). A review of the Resource-Based Relative Value Scale. Final report-Revised (Prepared for the American Medical Association). Washington, DC: Consolidated Consulting Group.
18. Fisher, C. (2006, October 18). Trends in physician office multifactor productivity-An exploratory analysis. Paper presented at the ASPE/CMS Physician Productivity Conference, Washington, DC.
19. Ghosh, N., Yee, R., Klein, G.J., Quantz, M., Novick, R.J., Skanes, A.C., & Krahn, A.D. (2005). Laser lead extraction: Is there a learning curve ? Pacing and Clinical Electrophysiology, 28, 180-184.
20. Ginsburg, P.B., & Berenson, R.A. (2007). Revising Medicare's physician fee schedule-Much activity, little change. New England Journal of Medicine, 356, 1201-1203.
21. Grzybicki, D.M., Sullivan, P.J., Oppy, J.M., Bethke, A.M., & Raab, S.S. (2002). The economic benefit for family/general medicine practices employing physician assistants. American Journal of Managed Care, 8, 613-620.
22. Health Care Financing Administration. (1996). Medicare claims review & adjudication procedures: Global surgery (sections 4820-4830, 4-551-554-574). Washington, DC: Author.
23. Hsiao, W.C., Braun, P., Becker, E.R., Dunn, D.L., Kelly, N., Causino, N.,.. Rodriguez, E. (1992). Results and impacts of the Resource-Based Relative Value Scale. Medical Care, 30 (Suppl. 11), NS61 - NS79.
24. Hsiao, W.C., Braun, P., Becker, E.R., Dunn, D.L., Kelly, N., & Causino, N. (1988). A national study of resource-based relative value scales for physician services: Phase 1. Final report (Report prepared for the Health Care Financing Administration). Boston, MA: Harvard University.
25. Hsiao, W.C., Braun, P., Yntema, D., & Becker, E.R. (1988). Estimating physicians' work for a resource-based relative value scale. New England Journal of Medicine, 319, 835-841.
26. Iezzoni, L.I. (1999). The demand for documentation for Medicare payment. New England Journal of Medicine, 341, 365-367.
27. Kassirer, J.P., & Angell, M. (1998). Evaluation and management guidelines-Fatally flawed. New England Journal of Medicine, 339, 1697-1698.
28. Lasker, R.D., & Marquis, M.S. (1999). The intensity of physicians' work in patient visits- Implications for the coding of patient evaluation and management services. New England Journal of Medicine, 341, 337-341.
29. Liederman, E.M., Lee, J.C., Baquero, V.H., & Seites, P.G. (2005). The impact of patient-physician Web messaging on provider productivity. Journal of Healthcare Information Management, 19 (2). 81-86.
30. Maxwell, S., Zuckerman, S., & Berenson, R.A. (2007). Use of physicians' services under Medicare's resource-based payments. New England Journal of Medicine, 356, 1853-1861.
31. McCall, N., Cromwell, J., & Braun, P. (2006). Validation of physician survey estimates of surgical time using operating room logs. Medical Care Research and Review, 63, 764-777.
32. McCarthy, E.L. (2002). Physician office productivity improvement through operations analysis and process redesign. Journal of Ambulatory Care Management, 25 (4). 37-52.
33. Medicare Payment Advisory Commission. (2005). Report to the Congress: Medicare payment policy. Washington, DC: Author.
34. Medicare Payment Advisory Commission. (2006, January). Valuing physician services. Paper presented at the Medicare Payment Advisory Commission Public Meeting, Washington, DC.
35. Mitchell, J. (1985). Physician DRGs. New England Journal of Medicine, 313, 670-675.
36. Mohr, C.J., Nadzam, G.S., & Curet, M.J. (2005). Totally robotic Roux-en-Y gastric bypass. Archives of Surgery, 140, 779-786.
37. Moore, M.J., & Bennett, C.L. (1995). The learning curve for laparoscopic cholecystectomy. The Southern Surgeons Club. American Journal of Surgery, 170, 55-59.
38. Morton, S.C., Kominski, G.F., & Kahan, J.P. (1994). An examination of the Resource-Based Relative Value Scale cross-specialty linkage method. Medical Care, 32, 25-39.
39. Newhouse, J., & Sinaiko, A.D. (2006, October 18). Adjusting for physician productivity in the Medicare fee schedule. Paper presented at the ASPE/CMS Physician Productivity Conference Washington, DC.
40. Oliak, D., Ballantyne, G.H., Weber, P., Wasielewski, A., Davies, R.J., & Schmidt, H.J. (2003). Laparoscopic Roux-en-Y gastric bypass: defining the learning curve. Surgical Endoscopy, 17, 405-408.
41. Part B News. (2000). Part B News, 14. Gaithersburg, MD: Decision Health.
42. Physician Payment Review Commission (1989). Annual report to Congress, 1989. Washington, DC: Author.
43. Physician Payment Review Commission. (1993). Annual report to Congress, 1993. Washington, DC: Author.
44. Prospective Payment Assessment Commission. (1986). Report and recommendations to the Secretary, U.S. Department of Health & Human Services. Washington, DC: U.S. Government Printing Office.
45. Ramsey, F., & Schafer, D. (2002). The statistical sleuth: A course in methods of data analysis (2 nd ed.). Pacific Grove, CA: Duxbury.
46. Rodysill, K.J. (2003). Increasing physician productivity using a physician extender: A study in an outpatient group practice at the Mayo Clinic. Journal of Medical Practice Management, 19, 110-114.
47. Schauer, P., Ikramuddin, S., Hamad, G., & Gourash, W. (2003). The learning curve for laparoscopic Roux-en-Y gastric bypass is 100 cases. Surgical Endoscopy, 17, 212-215. (Pubitemid 36173269)
48. Schijven, M.P., & Jakimowicz, J. (2004). The learning curve on the Xitact LS 500 laparoscopy simulator: Profiles of performance. Surgical Endoscopy, 18, 121-127.
49. U.S. Department of Health & Human Services, Centers for Medicare & Medicaid Services. (2004). Physician fee schedule (2005 CY): Payment policies and relative value units adjustment. Federal Register, 69, 66235-66915.
50. U.S. Department of Health & Human Services, Centers for Medicare & Medicaid Services. (2006). Medicare program: Five-year review of work relative value units. Federal Register, 71, 37170-37430.
51. U.S. Department of Health & Human Services, & Health Care Financing Administration. (1992). Medicare program: Fee schedule for physicians' services for calendar year 1993- HCFA. Final notice with comment period. Federal Register, 57, 55914-56167.
52. U.S. Department of Health & Human Services, & Health Care Financing Administration. (1996). Medicare program: Five-year review of work relative value units. Federal Register, 61, 19991-20067.
53. U.S. Department of Health & Human Services, & Health Care Financing Administration. (1999). Medicare Program; Revisions to payment policies under the physician fee schedule for calendar year 2000: Final rule. Federal Register, 64, 59379-59428
54. Woodwell, D.A. (1999). National Ambulatory Medical Care Survey: 1997 summary. Atlanta, GA: Centers for Disease Control and Prevention.