McCormack LA, Burge RT, Ammering CJ, Mitchell JB.

AHSR FHSR Annu Meet Abstr Book. 1994; 11: 130-1.

PROBLEM AND OBJECTIVES. The primary purpose of this study was to evaluate the extent to which the Resource-Based Relative Value Scale (RBRVS) and physician payment policies accompanying the Medicare Fee Schedule (MFS) are viable options for non-Medicare payers. DATA AND METHODS. Two research methods were utilized. The first involved analysis of survey data on 333 payers across eight organization categories on the diffusion of RBRVS. It included over 50 questions about the methods payers use or anticipate using to compensate physicians. The second method used was in-depth case studies of a dozen payers--six public and six private-- adopting or actively considering an RBRVS-based system. The case studies served as a vehicle for acquiring detailed, qualitative information about the process payers used to develop RBRVS-based payment systems. RESULTS AND CONCLUSIONS. One-third of the sample adopted RBRVS while another 40% of respondents were actively considering its adoption; payers most likely to adopt RBRVS are Blue Cross/Blue Shield plans, IPA-model HMOs and PPOs; 15 of 48 Medicaid programs adopted RBRVS and another 11 are actively considering adoption; and penetration of RBRVS is greatest in managed care products, accounting for 75% of all affected insurance products. Concerns about adverse impacts on physician relations, the newness of RBRVS, and uncertainty of national health reform create barriers to adopting RBRVS. Expectations and goals for RBRVS include increasing fees for primary care services, redistributing payments to improve access to care, and controlling cost growth. Payers generally perceive the underlying RBRVS principles to be sound, yet one-third of the adopters modified or replaced HCFA RVUs in at least one area of medicine, predominantly in pediatrics, obstetrics and gynecology. Medicare's surgical payment policies were most likely to by adopted with few modifications. Finally, many payers expect RBRVS to acieve cost containment, but through means other than volume performance standards (VPS). IMPLICATIONS FOR AUDIENCE: The potential for RBRVS to become the cornerstone for broader physician payment reform is substantial, as evidenced by the adoption rates found in this study. Widespread use of the other two major components of the MFS -- Medicare VPS and payment policies -- appears unlikely, however.

Publication Types:

• Meeting Abstracts

Keywords:

• Child
• Data Collection
• Diffusion
• Fee Schedules
• Humans
• Managed Care Programs
• Medicaid
• Medicare
• Medicare Part B
• Pediatrics
• Physicians
• Preferred Provider Organizations
• Primary Health Care
• Relative Value Scales
• economics
• hsrmtgs

Other ID:

• HTX/94911025

UI: 102212172

From Meeting Abstracts