Physician Payment Review Commission Research Articles

Can all-payer rate setting and the competitive strategy coexist?

Prologue: The endless debate over the future shape of our health care financing system has focused on the continuum between market competition and government regulation and the question: Which is right for America? The 1980s and early 1990s marked a period when the administrations of Ronald Reagan and George Bush articulated a rhetorical commitment to competition, but it also was an era in which the federal government introduced administered pricing for hospitals and physicians in Medicare. The rhetorical struggle between advocates of the two ideologic camps continues, but in the past year, politicians at the federal and state levels have shown more inclination to propose tighter regulatory controls as their favored prescription for dealing with soaring medical expenditures. Reflections of this rekindling interest are the incorporation of regulatory controls in health financing reform proposals put forward by Democrats, including Senate Majority Leader George Mitchell. State legislators also are looking more favorably at the regulatory model. The New York Times reported May 11: “After a decade in which health costs rose rapidly and many people lost access to care, state and local health officials around the country are returning to the kind of planning denounced by the Reagan Administration as a tool of heavy-handed government regulation.” In this paper, Paul Ginsburg and Ken Thorpe ask the inevitable question, given America's penchant for compromise: Can competitive and regulatory approaches coexist in a pluralistic system that derives most of its resources from the private sector, but one that cannot be sustained financially, given its soaring rate of growth? Ginsburg, who holds a doctorate in economics from Harvard University, is director of the Physician Payment Review Commission. Thorpe, also an economist, teaches at the University of North Carolina, Chapel Hill.

The Trials of Medicare Physician Payment Reform

IS MEDICARE physician payment reform in jeopardy? Physicians' organizations, including the American Medical Association (AMA), specialty societies, and state medical associations, have expressed alarm about the content of the Notice of Proposed Rulemaking (NPRM) that was published on June 5 by the Health Care Financing Administration (HCFA) to implement the Medicare Fee Schedule. For editorial comment see p 1566. What are the problems that are causing so much concern among physicians? Did physicians misinterpret the 1989 legislation that reformed physician payment? Or did HCFA propose rules that do not reflect the intent of Congress and fall short of physicians' expectations concerning accurate resource-based relative values? In this Commentary, we discuss these issues from the perspective of the Physician Payment Review Commission (PPRC). <h3>Background</h3> In December 1989, Congress passed a comprehensive physician payment reform for Medicare that included a resource-based fee schedule, limits on balance billing, and a mechanism to update

Whom Can We Trust?

Since 1986, the American Medical Association has embraced the concept of physician payment reform. This was done for three reasons: payments were seen to be inequitable among specialties, there was no predictability as to what the standard payments were to be, and the Congress was constantly changing the rules and whipsawing the profession as the federal budget crunches became ever greater. In many respects, this was not necessarily in the best interests of some physicians, yet it was seen as a way to bring order out of chaos in physician payment, and, though skeptical, the profession continued its participation. Finally in 1989, the Congress, on the advice of the Physician Payment Review Commission (PPRC), enacted legislation implementing the new payment schedule based on resource consumption, beginning in 1992 and completed through a transition period by 1996. So far so good. Not everyone was happy, nor was the system adequately fine-tuned,

The Physician Payment Review Commission

Log in or Register Subscribe to journalSubscribe Get new issue alertsGet alerts Enter your Email address: Wolters Kluwer Health may email you for journal alerts and information, but is committed to maintaining your privacy and will not share your personal information without your express consent. For more information, please refer to our Privacy Policy. Subscribe to eTOC Secondary Logo Journal Logo All Articles Images Videos Podcasts Blogs Advanced Search Toggle navigation Subscribe Register Login Articles & Issues Current IssuePrevious IssuesPublished Ahead-of-Print Collections Editorials of Laura Weiss Roberts, MD, MAAM Last PageCOVID-19 and Medical EducationAddressing Race and Racism in Medical EducationeBooksView All For Authors Submit a ManuscriptInformation for AuthorsLanguage Editing ServicesAuthor Permissions Journal Info About the JournalAbout the AAMCJournal MastheadSubmit a ManuscriptAdvertising InformationSubscription ServicesReprints and Back IssuesClassified AdsRights and PermissionsFor ReviewersFor MediaFor Trainees All Articles Images Videos Podcasts Blogs Advanced Search

Legal Responses to Patient Injury: A Future Agenda for Research and Reform

Concern about liability for medical malpractice pervades our health care delivery system. A national data bank mandated by Congress now tracks all paid malpractice claims against physicians as well as information about disciplinary actions. When the Physician Payment Review Commission seeks to reform Medicare fees for physicians, an integral task is computing increments for reimbursing liability insurance premiums. Liability issues can affect medical decisions from obstetrical choice of delivery methods at the beginning of life to a determination whether to withdraw artificial life support at its end.

The role of the physician payment review commission in medicare payment reform

As an observer of the Physician Payment Review Commission, one is struck by the generous physician presence. As originally conceived, this make-up was perhaps appropriate. However, the policies inherent in the development of Medicare payment reform are changing the way many think regarding the value of health services and the manner of payment for such services. Nursing will be affected by these reforms. Cooperation, collaboration, consensus, and a strong united presence during the next year's deliberations by the Commission will serve the nursing profession well.

American Urological Association Survey of Transurethral Prostatectomy and the Impact of Changing Medicare Reimbursement

The American Urological Association, in a survey of all American urologists, found that TURP accounts for 38 per cent of their major surgery and also found that activities associated with the operation account for nearly 25 per cent of their total patient workload. American urologists regard TURP as complex, and they believe proficiency requires more practical case experience during residency training than is required for any other urologic operation. American urologists assign TURP a significantly higher relative value than that proposed in the pending national Medicare Fee Schedule formulated by medical economists and the Physician Payment Review Commission. The legislated reductions in allowable Medicare fees for TURP and the possible shift in management of benign prostatic hyperplasia to nonsurgical methods create a financial vulnerability for American urologists who remain economically dependent on this dominant operation. Adjustments in practice patterns and manpower policy planning may well be required.

Prescription Drugs, Practicing Physicians, and the Elderly

Prologue: A key element of the success of any medical regimen is the physician/patient relationship. Because of its potential impact on quality of care, policymakers retain a lively interest in this interaction. In this article, Risa Lavizzo-Mourey and John Eisenberg examine the impact of prescription drug policies on the physician/patient relationship, focusing on the elderly. “As clinicians and health services researchers, ” Eisenberg said, “we are interested in how public policy influences physicians' clinical decision making regarding their elderly patients—particularly policies that affect physicians' ability to prescribe or dispense pharmaceuticals.” As the nation forges a prescription drug policy, the authors urge that “drug benefits that are not neutral with regard to physicians' incentives to substitute medications for other therapies or to actually dispense medications should be implemented with caution because of the potentially negative impact on the doctor/patient relationship.” Lavizzo-Mourey and Eisenberg are both on the faculty of the University of Pennsylvania Medical School and are senior fellows at the University of Pennsylvania's Leonard Davis Institute of Health Economics. Lavizzo-Mourey, a clinically active geriatrician, received a medical degree from Harvard Medical School and a master of business administration degree from the Wharton School. She is affiliated with the Section of General Internal Medicine and the Center for the Study of Aging at the University of Pennsylvania. Eisenberg, an internist, received his medical degree from Washington University in St. Louis, Missouri, and holds a master of business administration degree from the Wharton School. He is chief of the Section of General Internal Medicine and Sol Katz Professor of General Internal Medicine at the University of Pennsylvania and is a member of the Physician Payment Review Commission. Both Lavizzo-Mourey and Eisenberg are alumni of The Robert Wood Johnson Foundation Clinical Scholars Program.

Physician Payment Reform: Implications for Geriatrics

A consensus has developed on the need for a major revision of physician reimbursement in the Medicare program. The Physician Payment Review Commission has recommended to Congress a series of far-reaching changes in the payment system, based on the development of a fee schedule using a Resource Based Relative Value System (RBRVS). This article explores the rationale for the recommendations and the probable impact on Medicare beneficiaries and their physicians if the changes are enacted. Special consideration is given to unique aspects of geriatric medicine, including comprehensive geriatric assessment.

Physician payment reform: Congress's turn.

Editorials1 September 1989Physician Payment Reform: Congress's TurnRobert A. Berenson, MDRobert A. Berenson, MDSearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-111-5-351 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptThe Physician Payment Review Commission (PPRC), created by law in 1986 to advise Congress on reforming methods for Medicare payments to physicians, issued its third annual report on 28 April 1989. The major recommendations are briefly summarized in the following excerpt from the Commission's report (1):To rationalize the pattern of payments by Medicare, the Commission proposes a Medicare Fee Schedule based primarily on resource costs. To limit beneficiary financial liability, it recommends limits on balance billing. To control the growth in expenditures, the Commission proposes the use of expenditure targets, increased research on the effectiveness of medical...

Physician Payment Review Commission Reports to Congress: Move Forward on Payment Reform

Journal Article Physician Payment Review Commission Reports to Congress: Move Forward on Payment Reform Get access Laboratory Medicine, Volume 20, Issue 7, 1 July 1989, Pages 469–470, https://doi.org/10.1093/labmed/20.7.469 Published: 01 July 1989

The Physician Payment Review Commission Report to Congress

THE PHYSICIAN Payment Review Commission has developed proposals to rationalize the pattern of payments to physicians by Medicare and to slow the rate of increase in program costs so that they are affordable to beneficiaries and taxpayers. It outlines these proposals in its 1989 report, submitted to Congress today. The Commission was created in 1986 to advise Congress on reform of the methods used by Medicare to pay physicians. The Congress expanded its charge in 1988 to include consideration of policies designed to slow the rates of increase in expenditures and utilization of physicians' services. Medicare is the nation's largest payer of medical bills in an industry that now accounts for more than 11% of the gross national product. Its expenditures have grown rapidly over the years, with spending for physicians' services being the fastest growing portion, rising an average of 15% a year. Taxpayers and beneficiaries pay for these

The Physician Payment Review Commission report to Congress

The Physician Payment Review Commission report to Congress

The Recommendations of the Physician Payment Review Commission

THE relations between Medicare and practicing physicians, increasingly conflicted by the economic imperatives of payer and provider, will continue to evolve this year on two related but separate fronts. One involves the government's continuing struggle to reduce the massive federal deficit. A second more fundamental development centers on proposed new policies, some sought by organized medicine and others strongly opposed by it, that would seek to rationalize Medicare payment levels through a physicians' fee schedule, enact further limits on balance billing, impose an expenditure target on physicians' services for the first time, and accelerate the development of guidelines for medical . . .

Health Care Spending and American Competitiveness

American business plays a curious role in the health policy-making activities of the United States. Its degree of involvement falls well short of the magnitude of its massive commitment to financing the medical care of its employees. The reasons for its limited involvement are multiple. Corporate chieftains have been slow to engage the complex issues of health financing because such issues are usually not central to their businesses. They prefer to wield the limited influence any individual or institution can bring to bear on public policy making on matters that seemingly affect their respective bottom lines more directly. Beyond this point, American corporations have been ambivalent about promoting a more pervasive role for government in health financing and delivery because of their general philosophical distaste for regulation. In recent years, though, one argument has resonated with chief executive officers who have been exhorted by their employee benefits managers to become more heavily involved in health policy making—the notion that America's soaring medical bill is making corporations less competitive in world markets. In this paper, Uwe Reinhardt of Princeton University challenges this argument, asserting that it is unlikely that high health costs per se render American business noncompetitive at home or abroad. Reinhardt, who was born in Germany, was educated in Canada and the United States, and is now a naturalized U.S. citizen, is a familiar figure in health policy circles. He plays multiple roles: as a policymaker, who employs his international perspective to influence the directions of American policy; as a speaker, who uses humor to educate and inform; and as a writer, who effectively marshals his argument on behalf of whatever case he is striving to build. Reinhardt was a very active participant in the National Leadership Commission on Health Care (see exchange with J. Bruce Johnston in Health Affairs, Summer 1989), and has also been an influential voice on the Physician Payment Review Commission.

Perspectives: Objective Research And Physician Payment: A Response From Harvard

Research Article Health AffairsVol. 8, No. 4 Perspectives: Objective Research And Physician Payment: A Response From HarvardWilliam C. Hsiao AffiliationsHarvard University School of Public Health. He has been developing resource-based relative value scales for more than a decade.PUBLISHED:Winter 1989No Accesshttps://doi.org/10.1377/hlthaff.8.4.72AboutSectionsView articleView Full TextView PDFPermissions ShareShare onFacebookTwitterLinked InRedditEmail ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions View articleTOPICSResource-based relative value scalePhysician paymentGovernment programs and policiesMarketsHealth servicesPoliticsQuality of careCosts and spending Loading Comments... Please enable JavaScript to view the comments powered by Disqus. DetailsExhibitsReferencesRelated Article MetricsCitations: Crossref 5 History Published online 1 January 1989 InformationCopyright © by Project HOPE: The People-to-People Health Foundation, Inc.PDF downloadCited byHealth Services Research as a Source of Legislative Analysis and Input: The Role of the California Health Benefits Review ProgramHealth Services Research, Vol. 41, No. 3p2Health care reform: Informing difficult choicesInternational Journal of Health Planning and Management, Vol. 10, No. 4Analysis, Advice, and Congressional Leadership: The Physician Payment Review Commission and the Politics of MedicareJournal of Health Politics, Policy and Law, Vol. 18, No. 1The Struggle over Physician-Payment ReformNew England Journal of Medicine, Vol. 325, No. 11The New Law on Medicare's Payments to PhysiciansNew England Journal of Medicine, Vol. 322, No. 17

Addressing The Health of a Nation: Two Views

Prologue: America's health care system is in turmoil for many reasons, but one seemingly overrides all others. Payers of care are increasingly restive over its escalating cost and seem determined to take action to address the problem. One reflection of this mounting concern was the creation in 1986 of the National Leadership Commission on Health Care and its recent recommendations for a major restructuring of the system. The commission brought together a distinguished cast of leaders from health care, business, economics, politics, ethics, and law to develop workable solutions to current problems. The commissions report recommended that the United States provide all of its citizens access to a basic level of care, that it strive to control costs through wider use of innovative purchasing of care, and that it greatly expand research on the quality and appropriateness of care. Most members of the commission endorsed the recommendations. Several did not, including Walter E. Burdick of the IBM Corporation, Theodore Cooper of the Upjohn Company, Harry Garber of the Equitable Life Assurance Society of the United States,]. Bruce Johnston of the USX Corporation, Douglas S. Peters of the Blue Cross and Blue Shield Association, and James H. Sammons of the American Medical Association. In the following exchange, Uwe Reinhardt of Princeton University challenges the expressed views of Bruce Johnston. Reinhardt, an economist, was a member of the commission and also serves as an active participant of the Physician Payment Review Commission. Johnston, in turn, reacts to Reinhardt's expressed views. Johnston started his career at USX, a Pittsburgh-based conglomerate, as a laborer working in steel mills while attending the University of Pittsburgh, from which he holds degrees in government and economics and in law. Until recently, he was executive vice-president for employee relations at USX. In spring 1989 he left the company after thirty-five years to join the Pittsburgh law firm Alder, Cohen, Grigsby.

The resource-based relative value scale for physician compensation under Medicare. Implications for ophthalmology.

The long-awaited report by Hsiao and colleagues 1-4 was recently released and has been published in national medical journals. It details the conclusions of a governmentally appointed commission to study a resource-based, relative value scale for Medicare reimbursement of physician services. If adopted, the commission's recommendations would have important implications regarding the compensation of physicians in general and ophthalmologists in particular. Indeed, in the original release, it was indicated that ophthalmology might witness a 40% decline in Medicare revenues. 3 At the time of this writing, data were not available to determine the basis for this projection. However, limited information has been published and may be examined. 2 Because even the anticipation of the release of the study had induced substantial concern and controversy, its genesis, methodology, and possible impact on ophthalmology bear discussion. GENESIS OF THE STUDY Under a mandate from Congress, the Physician Payment Review Commission, an advisory

Resource-Based Relative Values

Studies have been conducted over the past decade to develop a Resource-Based Relative Value Scale (RBRVS) for physicians' services. Policymakers view an RBRVS as a potential tool to pay physicians. The Physician Payment Review Commission, under a congressional mandate, has endorsed the general concept of a fee schedule based on resource costs for physician payment under Medicare. In this overview article, we present the policy context in which the RBRVS may play a role and describe the approach taken to develop this scale, specifically consultation with clinicians, researchers, and insurers and data gathering, including a national survey of physicians. We discuss underlying elements that are necessary to constructing an RBRVS, each of which is described more fully in subsequent articles: measuring the work (intraservice work) of performing medical services and procedures, estimating preservice and postservice work, comparing work across specialties, measuring practice costs, extrapolating from surveyed services, and establishing an RBRVS for evaluation/management services and for invasive procedures. Overall results are presented in a companion article.

Physician Payment Reform: An Idea Whose Time Has Come

The articles by Hsiao and associates 1-9 in this issue ofTHE JOURNALon the development of a Resource-Based Relative Value Scale (RBRVS) are certain to stir controversy among physicians. Because of growing dissatisfaction with Medicare's prevailing, and method of determining payments to physicians, Congress in 1984 mandated a study of relative values. In 1986, Congress also established the Physician Payment Review Commission to advise it on reforms in Medicare's methods of physician payment. Physician Payment Reform The customary, prevailing, and reasonable method has been criticized by many for encouraging fee inflation and causing serious distortions in the relative payments for different types of services and across geographic areas. 10-14 It has given practicing physicians inappropriate economic signals concerning how to practice, what specialty to choose, and in which locality to set up a practice, as well as causing inequities among them. Finally, the customary, prevailing, and reasonable