Comparison of nurse practitioner and family physician relative work values.
Comparison of nurse practitioner and family physician relative work values.
复制标题
执业护士和家庭医生相对工作价值观的比较。
DOI：
10.1111/j.1547-5069.2000.00071.x
复制
发表时间：
2000
期刊：
影响因子：
--
通讯作者：
G. Maislin
中科院分区：
文献类型：
--
作者：
E. Sullivan;G. Maislin
目的
随着1997年平衡预算法案的颁布，美国护士从业者获得了B部分服务的直接医疗保险报销。按服务收费和管理医疗系统中的支付结构是以医生为基础的，导致难以为其他医疗保健专业人员建立付款。这项初步研究的目的是检验使用护士从业人员数据在三个诊疗代码的医疗保险费用表中指定相对工作值的可行性。
设计
设计了一项探索性调查，以使用震级估计标度来确定相对功值。护士从业者(N=43)在全国邮寄调查中回答了结构化问卷。医生数据(N=46)来自美国家庭医生学会的计算机化数据库。
方法
这项研究中使用的方法与美国医学会和卫生保健融资管理局在医疗保险费用表中建立相对工作价值观所使用的过程相同。受访者为初级保健实践中常见的三个当前的办公室就诊程序术语代码(99203、99213、99215)建立了相对工作价值观。每个CPT代码描述符和相关的片段与参考服务相比较，参考服务与护士从业人员和家庭医生的实践密切相关，使用幅度估计标度。为了确定每个代码的相对工作价值，受访者被要求考虑为每个CPT代码提供服务的时间和涉及的工作强度。
调查结果
在三个CPT代码中，护士从业者和家庭医生在相对工作价值和强度方面没有显著差异。与家庭医生相比，执业护士估计在服务中(面对面)与患者相处的时间显著更长(p<；.01)，家庭医生估计两个代码的服务前时间显著(p<；.05)更长，三个代码的服务后时间显著(p<；.05)更长。
结论
护士从业者的相对工作价值观与家庭医生的相对工作价值观没有显著差异。尽管样本量很小，但这些发现的重要性支持了进一步研究的需要，即需要使用大型数据集和额外的CPT代码。这样的研究可以作为决定医疗保险支付和公共政策的基础。
PURPOSE
With the enactment of the Balanced Budget Act of 1997, American nurse practitioners were granted direct Medicare reimbursement for Part B services. Payment structures in fee-for-service and managed care systems are physician-based, leading to difficulties in constructing payments for other health care professionals. The purpose of this pilot study was to examine the feasibility of using nurse practitioner data for specifying relative work values in the Medicare Fee Schedule for three office-visit codes.
DESIGN
An exploratory survey was designed to establish relative work values using magnitude-estimation scaling. Nurse practitioners (N = 43) responded to a structured questionnaire in a national mail survey. Physician data (N = 46) were obtained from a computerized database from the American Academy of Family Physicians.
METHODS
The methods used in this study were the same as the process used by the American Medical Association and the Health Care Financing Administration to establish relative work values in the Medicare Fee Schedule. Respondents established relative work values for three Current Procedural Terminology (CPT) codes for office visits (99203, 99213, 99215) commonly billed in primary care practice. Each CPT code descriptor and associated vignette were compared with reference services germane to the practice of nurse practitioners and family physicians, using magnitude-estimation scaling. To establish relative work values for each code, respondents were asked to consider the time to provide the service and intensity of the work involved for each CPT code.
FINDINGS
No significant differences between nurse practitioners and family physicians were found in the three CPT codes for relative work values and intensity. Nurse practitioners estimated significantly (p < .01) higher intraservice (face to face) time with patients than did family physicians, and family physicians estimated significantly (p < .05) higher pre-service time for two codes and significantly (p < .05) higher postservice times for three codes.
CONCLUSIONS
Nurse practitioner relative work values did not differ significantly from family physician relative work values. Although the sample sizes were small, the significance of the findings support the need for further research with large data sets and additional CPT codes. Such studies could then be used as a basis for decisions about Medicare payment and public policy.