Research Brief
RAND Modeling Offers Support for Transparent and Consistent CMS Physician Fee Schedules
Jan 16, 2015
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The Centers for Medicare & Medicaid Services (CMS) uses the resource-based relative value scale to pay physicians and other practitioners for professional services. The work values measure the relative levels of professional time and intensity (physical effort, skills, and stress) associated with providing services. CMS asked RAND to develop a model to validate the work values using external data sources. RAND's goal was to test the feasibility of using external data and regression analysis to create prediction models to validate work values. Data availability limited the models to surgical procedures and selected medical procedures typically performed in an operating room. Key findings from the study include the following: RAND estimates of intra-service time using external data are typically shorter than the current CMS estimates. Model assumptions about how shorter intra-service times affect procedure intensity have implications for the work estimates. RAND estimates for work on average were similar to current work values if shorter intra-service time is assumed to increase procedure intensity and were on average up to 10 percent lower than current work values if shorter intra-service time is assumed to not impact on procedure intensity. The RAND estimates could be used for two key applications: CMS could flag codes as potentially misvalued if the RAND estimates are notably different from the current CMS values. CMS could also use the RAND estimates as an independent estimate of the work values. In some cases, further review will identify a clinical rationale for why a code is valued differently than the RAND model predictions.
Chapter One
Introduction
Chapter Two
Descriptive Statistics of Total Work and Components of Work
Chapter Three
Methodological Approach and Data
Chapter Four
Intra-Service Times for Single Procedures
Chapter Five
Pre-Service and Immediate Post-Service Work
Chapter Six
Post-Operative Evaluation and Management Work
Chapter Seven
Intra-Service Work and Intra-Service Intensity (IWPUT)
Chapter Eight
Estimating Total Work RVUs
Chapter Nine
Other Issues
Chapter Ten
Key Findings and Potential Applications of the RAND Models
Appendix A
Defining Core Codes for Analyses
Appendix B
Explanation of Code Groupings
Appendix C
Explanation of Variables Used to Characterize Each Service
Appendix D
Estimating Surgical Times from Anesthesia and OR Times
Appendix E
A Bayesian Approach to Estimating Intra-Service Times
Appendix F
Multiple Procedures and Add-On Procedures
Appendix G
Regression Output from Pre-Service, Intra-Service, Post-Service, and Total Work Prediction Models
Appendix H
Comparison of Unweighted Means in RAND Estimates to CMS Estimates
This study was funded by the Centers for Medicare & Medicaid Services. This research was conducted in RAND Health, a division of the RAND Corporation.
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