Physician-payment reform - unfinished business

Article Abstract:

Medicare's resource-based relative-value scale (RBRVS), a physician-payment reform implemented in Jan 1992, has four primary goals. The first goal of the RBRVS is to ensure that physicians receive a fair payment in exchange for their services. The fee-for-service system will increase payments to primary care physicians and decrease payments to specialists. Another goal is to control the cost of medical care. The third goal is to ensure access to medical treatment for all patients by reducing the amount that poor and non-poor Medicare patients are required to pay for services. The RBRVS also attempts to improve the quality of patient care by limiting treatment to necessary procedures, and increasing support for preventative treatment. The RBRVS raises many new questions, and it may not fulfill its four goals for many reasons. Physicians need to work with the government to ensure that these guidelines are modified as necessary to meet the needs of both physician and patient.

Economic aspects, Medicare, Relative value scale payment systems (Medical care)

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Influence of cardiac-surgery performance reports on referral practices and access to care: a survey of cardiovascular specialists

Article Abstract:

An annual report in Pennsylvania that grades doctors and hospitals by examining hospital mortality rates appears to have little credibility with the state's cardiologists and heart surgeons. Researchers surveyed 279 cardiologists and 58 heart surgeons practicing in Pennsylvania. All of the surgeons and 82% of the cardiologists were aware of the annual report. Most cardiologists ignored the report when it came to referring patients to a surgeon. Many believed mortality rates alone do not completely reflect the quality of care. Many also believed that sicker patients would not be treated because they would be more likely to die.

Surgery, Medical care, Quality management, Medical care quality, Beliefs, opinions and attitudes, Cardiologists

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