Physician payment reform in Medicare

Article Abstract:

Although changes were introduced into Medicare's billing system between 1984 and 1987, the system has not been altered fundamentally, and it still suffers from important flaws. These include: geographic variation in prices; variation in payment for the same service carried out by different medical specialties; high prices for new procedures, even if they have become common; and different charges for physician visits versus surgical or procedural services. Service volume has increased in recent years, which can result from more intensive care per Medicare enrollee, separate billing for services that were formerly lumped together, or different ways of describing services for billing purposes. Current reform strategies determine physician payments based on a relative value scale (RVS), which aims at more fair ways of pricing individual services. Relative value for a procedure is a consequence of the physician work it requires; the practice expense it engenders; and a malpractice component. The Physician Payment Review Commission (PPRC), set up in 1986, evaluates the effects of Medicare reform, and development of a resource-based RVS was undertaken shortly after the establishment of the PPRC. No RVS, though, can limit the volume of physician services; hence, costs will never be entirely controlled by such an approach. A proposal was made for an annual expenditure target, designed, in part, to encourage physicians to develop practice guidelines. The Omnibus Budget Reconciliation Act of 1989 established a new resource-based RVS to determine Medicare fees in the context of annual standards of volume. Fees will be determined according to the relative value for the service, the conversion factor for the year, and a geographic adjustment factor. The new payment schedule is said to reflect a move away from fee regulation by the marketplace, and toward fee regulation by government policy. (Consumer Summary produced by Reliance Medical Information, Inc.)

Economic aspects, Medicare, Physician services utilization, Medical fees, Relative value scale payment systems (Medical care)

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A user's view of health care data management

Article Abstract:

As the cost of health care continues to increase, businesses are looking for new ways to reduce costs without sacrificing the quality of care provided. Businesses are turning toward purchasing the least the expensive health care programs available, and many of the programs purchased through health maintenance organizations and preferred provider organizations are chosen based on cost only. This practice has raised many questions about the quality of the health care provided. New methods of evaluating the quality of the health are needed. One method of determining the effectiveness of medical care is to review available medical data regarding the morbidity and mortality associated with various diseases. Large medical data bases exist for cancer, heart disease, arthritis, stroke, kidney disease, high blood pressure and many other diseases. However, systems for integrating and evaluating all of this information are needed. Another issue is the proper use of medical care. Overuse, underuse, and misuse are common problems. Overuse occurs when unnecessary diagnostic tests are performed, either out of uncertainty, fear of malpractice, or desire for financial gain. Underuse occurs when access to services is limited or when services are refused by the patient. Misuse occurs when the provided services are performed poorly. The corporate physician should play an active role the management of health resources, and make judgements about the quality and validity of the health services that are purchased. (Consumer Summary produced by Reliance Medical Information, Inc.)

Management, Usage, Medical economics, Occupational health services, Health planning, Employee benefits

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Medical treatment effectiveness research

Article Abstract:

The Agency for Health Care Policy and Research (AHCPR) of the Department of Health and Human Services has the responsibility for implementing the Medical Treatment Effectiveness Program (MEDTEP), started in 1990 to improve the quality of patient care services. MEDTEP will evaluate health care with respect to its effect on patients' survival, functional capacity, and quality of life. It will also disseminate the information it generates, with an emphasis on care outcomes. Considerable variability exists in the health care provided to similar patients, according to published research studies over the past 20 years, much of which is the result of differences in treatment effectiveness or physicians' practice styles. The impact of such factors on patient care should be minimized; evidence supports the belief that, if practitioners are given better information about treatment outcomes, they will respond to it. MEDTEP has three main research areas: medical effectiveness and patient outcomes; database development; and research on dissemination methods. Projects that operate under each of these headings are briefly described. Such projects represent collaborative efforts between government and private parties to develop guidelines for good medical practice. AHCPR is located at 18-12 Parklawn Building, Rockville, MD 20857. Its organizational structure is diagrammed. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Planning, Medical care, Patients, Patient care, United States. Agency for Healthcare Research and Quality

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