PMID- 9293829
OWN - NLM
STAT- MEDLINE
DCOM- 19971001
LR  - 20190627
IS  - 0002-9610 (Print)
IS  - 0002-9610 (Linking)
VI  - 174
IP  - 2
DP  - 1997 Aug
TI  - Physician work effort and reimbursement for ruptured abdominal aortic aneurysms.
PG  - 136-9
AB  - BACKGROUND: Two major flaws have been previously identified in the resource-based 
      relative value scale (RBRVS): (1) inaccurate estimation of physician work effort; 
      and (2) RBRVS compression, which results in undervaluation of major surgical 
      procedures. The impact of RBRVS for physicians treating patients with ruptured 
      abdominal aortic aneurysms (RAAAs) has not been previously reported and is 
      important owing to the severity of the illness, the potential to quantitate 
      actual work effort, and the high percentage of these patients covered by 
      Medicare. PATIENTS AND METHODS: All patients were studied who underwent surgery 
      for RAAAs during a 5-year period encompassing the implementation of RBRVS. 
      Analysis included all physician services including vascular surgeons, 
      anesthesiologists, and all other medical specialists. Total work effort was 
      quantitated for each specialty in minutes/patient. The financial data were 
      obtained by reviewing all professional bills and reimbursements. Cost of service 
      was calculated to include physician compensation, practice overhead costs, and 
      malpractice expenses. RESULTS: In all, 84 patients underwent repair of a RAAA 
      with a mortality rate of 42%. Medicare was the primary insurance for 87% of 
      patients. The cost of service exceeded the reimbursement by 50% for vascular 
      surgeons, resulting in an average loss of $1,593/patient. Actual operative time 
      represented only 24% of total surgical work effort. Early death and a length of 
      stay (LOS) < or = 1 day for 24 patients resulted in a reimbursement rate of 
      $5.98/minute for surgeons. This gain was significantly offset by 30 patients with 
      a LOS > or = 14 days, resulting in a reimbursement rate of $1.94/minute for 
      vascular surgeons. Over the 5-year period there was a trend of decreasing 
      reimbursement for vascular surgeons (P <0.005) but not other physicians. Vascular 
      surgeons incurred a 28% decrease in reimbursement over the study period. 
      CONCLUSIONS: Physician reimbursement under RBRVS for the treatment of patients 
      with RAAAs is inadequate to cover the costs of providing this care. Reimbursement 
      trends and potential changes to the practice component of the RBRVS will further 
      aggravate the losses involved in caring for these very ill patients. Vascular 
      surgeons must continue to provide input to the Health Care Financing 
      Administration to help correct inequities built into RBRVS.
FAU - Morehouse, D L
AU  - Morehouse DL
AD  - Section of Vascular Surgery, Geisinger Clinic, Danville, Pennsylvania 17822-1343, 
      USA.
FAU - Elmore, J R
AU  - Elmore JR
FAU - Franklin, D P
AU  - Franklin DP
FAU - Youkey, J R
AU  - Youkey JR
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Am J Surg
JT  - American journal of surgery
JID - 0370473
SB  - IM
MH  - Anesthesiology/economics
MH  - Aortic Aneurysm, Abdominal/*economics/therapy
MH  - Aortic Rupture/*economics/therapy
MH  - Female
MH  - Humans
MH  - Male
MH  - Physicians/*economics
MH  - *Reimbursement Mechanisms
MH  - *Relative Value Scales
MH  - United States
MH  - Vascular Surgical Procedures/economics
EDAT- 1997/08/01 00:00
MHDA- 1997/09/18 00:01
CRDT- 1997/08/01 00:00
PHST- 1997/08/01 00:00 [pubmed]
PHST- 1997/09/18 00:01 [medline]
PHST- 1997/08/01 00:00 [entrez]
AID - S0002961097900714 [pii]
AID - 10.1016/s0002-9610(97)90071-4 [doi]
PST - ppublish
SO  - Am J Surg. 1997 Aug;174(2):136-9. doi: 10.1016/s0002-9610(97)90071-4.