RESULTS AND POLICY IMPLICATIONS OF THE RESOURCE-BASED RELATIVE-VALUE STUDY
RESULTS AND POLICY IMPLICATIONS OF THE RESOURCE-BASED RELATIVE-VALUE STUDY
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DOI：
10.1056/nejm198809293191330
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发表时间：
1988-09-29
影响因子：
158.5
通讯作者：
KETCHAM, TR
中科院分区：
文献类型：
--
作者：
HSIAO, WC;BRAUN, P;KETCHAM, TR
基于资源的相对价值量表（RBRVS）是衡量医生提供服务和程序时所花费的资源投入的相对水平。它是医生的工作投入，专业培训的机会成本，以及每个专业的相关实践成本的函数。本文介绍了基于资源的相对价值（RBRV）的四个主要专业-家庭医疗，内科，普通外科，胸心血管外科的选择程序。我们比较RBRV与当前的收费，并发现几个一般模式。侵入性程序通常补偿超过两倍的评估和管理服务的速度，当两者消耗相同的资源投入。影像学和实验室程序属于侵入性和评估和管理services.We之间的RBRVS的财务影响进行分析，通过开发一个简单的模型和模拟的影响RBRVS为基础的收费表医生的收入在各个专业。我们使用医疗保险的数据进行模拟下的“中立”的假设。结果表明，基于RBRVS的费用表对专业的影响不同。普通家庭医生可以从医疗保险中获得60%的收入，而普通眼科医生可能会损失40%的收入。对其他专业的影响介于这两者之间。
The resource-based relative-value scale (RBRVS) is a measure of relative levels of resource input expended when physicians produce services and procedures. It is a function of the physician's work input, the opportunity cost of specialty training, and the relative practice costs for each specialty. This paper presents resource-based relative values (RBRVs) for selected procedures of four major specialties — family practice, internal medicine, general surgery, and thoracic and cardiovascular surgery. We compare RBRVs with current charges and find several general patterns.Invasive procedures are typically compensated at more than double the rate of evaluation-and-management services, when both consume the same resource inputs. Imaging and laboratory procedures fall between invasive and evaluation-and-management services.We analyze the financial implications of the RBRVS by developing a simple model and simulating the effects of an RBRVS-based fee schedule on physicians' revenues in various specialties. We use Medicare data to perform the simulation under the "budget-neutral" assumption. Results show that an RBRVS-based fee schedule affects specialties differently. The average family practitioner could receive 60 percent more revenue from Medicare, whereas the average ophthalmologist could lose 40 percent of current revenues. The effects on other specialties fall between these two.