Are Some Surgical Procedures Overpaid?

摘要: Critics have long argued that the current Medicare method of physician reimbursement “overpays” certain surgical procedures. Frequently cited examples are coronary artery bypass graft surgery and lens procedures, for which technological improvements believed to greatly reduced physicians’ time effort. The “usual, customary, reasonable” (UCR) used set payment levels provides no mechanism readjusting reflect changes in production costs. Moreover, UCR approach assumes initially rates were equitable, an assumption increasingly is being called into question. A fundamental solution would be major reform system basic financial incentives facing physicians through options such as capitation. Another option simply reduce those procedures overpaid. Federal policymakers already opted this latter approach, starting with cataract surgery. To establish a procedure is, fact, overpaid, we need yardstick by compare its relative value other services. Relative values constructed from historically determined charges inadequate because they incorporate existing market distortions. based on actual resource costs more likely provide equitable basis comparison. Such resource-based scale (RBRVS) was developed Hsiao Stason, then refined Braun. This RBRVS takes account not only complexity medical service, but also associated