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Titolo:
PHYSICIAN WORK EFFORT AND REIMBURSEMENT FOR RUPTURED ABDOMINAL AORTIC-ANEURYSMS
Autore:
MOREHOUSE DL; ELMORE JR; FRANKLIN DP; YOUKEY JR;
Indirizzi:
GEISINGER MED CLIN,VASC SURG SECT DANVILLE PA 17822 GEISINGER MED CLIN,VASC SURG SECT DANVILLE PA 17822
Titolo Testata:
The American journal of surgery
fascicolo: 2, volume: 174, anno: 1997,
pagine: 136 - 139
SICI:
0002-9610(1997)174:2<136:PWEARF>2.0.ZU;2-6
Fonte:
ISI
Lingua:
ENG
Soggetto:
RELATIVE-VALUE SCALE; VASCULAR-SURGERY;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Science Citation Index Expanded
Citazioni:
9
Recensione:
Indirizzi per estratti:
Citazione:
D.L. Morehouse et al., "PHYSICIAN WORK EFFORT AND REIMBURSEMENT FOR RUPTURED ABDOMINAL AORTIC-ANEURYSMS", The American journal of surgery, 174(2), 1997, pp. 136-139

Abstract

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: Ali patients were studied who underwent surgery for RAAAs during a 5-year period encompassing the implementation of RBRVS. Analysis included ail physician services including vascular surgeons, anesthesiologists, and all other medical specialists. Total work effort was quantitated for each specialty in minutes/patient. The financialdata 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) less than or equal to 1 day for 24 patients resulted in areimbursement rate of $5.98/minute for surgeons. This gain was significantly offset by 30 patients with a LOS greater than or equal to 14 days, resulting in a reimbursement rate of $1.94/ minute for vascular surgeons. Over the B-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 studyperiod. 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 involvedin caring for these very ill patients. Vascular surgeons must continue to provide input to the Health Care Financing Administration to helpcorrect inequities built into RBRVS. (C) 1997 by Excerpta Medica, Inc.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 07/08/20 alle ore 18:20:35