Relative Value System Research Articles

The work relative value estimation assessment in China: an empirical research for common surgical procedures.

China's National Health Service Items Standard (NHSIS) establishes a relative value system and plays an important role in pricing. However, there are few empirical evaluations of the objectivity of the NHSIS-estimated relative value. This paper presents a comparison between physician work relative value units (wRVUs) estimates for 70 common surgical procedures from NHSIS and those from the U.S. Medicare Physician Fee Schedule (MPFS). We defined the ratio of the wRVUs for sample procedures to the benchmark procedure (inguinal hernia repair) as a standardized relative value unit (SRVU), which was used to standardize the data for both schedules. We examined the variances in the ranking and quantification of SRVUs across specialties and procedures, as well as how SRVUs impact procedure reimbursement prices between the two schedules. There was no systematic difference between MHSIS-estimated SRVUs and MPFS-estimated, but the dispersion of MPFS-estimated SRVU was greater than that of MHSIS-estimated, and the discrepancies increased with surgical risk and technical complexity. The discrepancies of SRVUs were significant in cardiothoracic procedures. Additionally, whether SRVUs were based on MPFS or MHSIS, there was a positive association between them and payment prices. However, in terms of the impact of SRVUs on payment pricing, the NHSIS system was lower than the MPFS system. China has made incremental progress in estimating the relative value of healthcare services, but there are shortcomings in valuation methods and their impact on pricing. The modular assessment method should be considered as a component to optimize reform.

Exploring Work Ethic in Ghana

This paper explores the philosophical, sociological and historical basis of work-ethic in Ghana, bearing in mind Marx Weber’s Protestant Work Ethic and its effects on largely Christian and capitalistic population of Ghana. It relies on normative ethics, the collective national perception of work and actual productivity in certain industries, the quality of made-in-Ghana goods and services, and the pursuit of professionalism, aided by extensive literature review and content analysis. The author raised the dialectical but main research question as to whether Ghana has a national ethical code beyond the imported Judo-Christian, and other faith-based but incongruent moral dictums on work. The second research question is whether the ethnic groups in Ghana have their unique but positive culturally relative or philosophical takes on work? Third inquiry was whether the myriad cultural values coalesce into a cultural ethical relative value system for Ghana? The key outcome of the exploration revealed, there appears to be disconnect between official rhetoric on productivity and the phenomenon of work in the nation and among the ethnic groups. This is due to the absence of a well-defined national or regional overarching moral basis for work. There is also the lack of the cultural estimation of productivity as a measure of a well-functioning workforce and society like Germany and Japan, or a more laissez faire nation like the United States of America. As novel as this paper is about Ghana’s work ethic, it may not inform policy on national productivity or even help to define the national work ethic, due to the fact that the author is not a politician with power over policy direction in Ghana.

Determination of the Validity and Reliability of the World Health Organization's Healthy Lifestyle Scale in the Kazakh Version based for University Students

The World Health Organization defines quality of life as people's perception of their position in life in the context of their cultural, value system in relation to their goals, expectations, standards and interests (World Health Organization, 1997). In many studies, quality of life has been defined as happiness, contentment, and stability, and the concept of quality of life has been used as a synonym for life satisfaction, content of life, and happiness. Nevertheless, life satisfaction, which is one of the most important determinants of quality of life, is individualistic in nature. The aim of the current study is to verify the validity and reliability of the WHO short form of quality of life (WHOQOL – Bref) in the Kazakh language. In this context, a total of 509 students, 208 men (40.9%) and 301 women (59.1) volunteered for the study. The scale consisted of 27 items and 5 smaller criteria (general health, physical health, psychological health, social relationships, and the environment). In the analysis of the study, a confirmatory factor analysis was used regarding the structural suitability of the inventory, and Cronbach Alpha reliability analysis was used to determine internal compliance. In conclusion, we can say that the «WHO brief form of quality of life (WHOQOL-Bref) in Kazakh» is a valid and reliable assessment tool.

Taylor’s Dilemma

This instructional case explores ethical and leadership issues within the context of public accounting. The case examines one senior manager in a public accounting firm who failed to receive an anticipated promotion to partner and the resulting discussions and actions that follow. The primary objectives of the case are (1) to increase students’ awareness of select ethical issues commonly faced by auditors as they attempt to serve the public trust, their clients, and their firms, and (2) to consider their own value system in relation to the issues identified in this case. The secondary learning objectives are to (1) increase students’ knowledge of the AICPA Code of Professional Conduct / IESBA Code of Ethics, (2) encourage consideration of the impact of ethical and unethical behaviors by auditors on others within the profession, and (3) illustrate how leadership within an organization influences the behaviors of others.

The micro administrative mechanism of land reallocation in land consolidation: A perspective from collective action

The implementation of land reallocation is stagnant in China for many reasons, among which the non-cooperation of farmers is a critical one. Although extensive research has been conducted to promote land reallocation, it is mainly confined to macro administrative or technical aspects, leaving studies on the micro administrative mechanism still absent. This paper deeply investigates incentives of farmers to participate in land reallocation, based on which we novelly analyse the interactions among farmers under two different scenarios. The results show that the number and heterogeneity of households involved in land reallocation make significant differences on achievement of collective action, and local governors should choose their strategies according to structure of the stakeholders group. Specifically, in land consolidation projects which involve a large-size group of small households, reducing costs incurred by the endowment effect is imperative. In projects which involve a small group of heterogeneous households, strategy that combines granting priority to small households in choosing land and constructing a farmland relative value system helps to reach agreements among households. In addition, an illustrative case study of Pengze project in Jiangxi province shows that introduction of land transfer in land consolidation projects can change structure of the stakeholders group, thereby facilitating implementation of land reallocation. Hence, a combination of land transfer and land consolidation projects can be a good solution to the stagnation of land reallocation.

Understanding Employees’ Preferences: Their Work Values, Environment, Interaction and Activities

This descriptive study aimed to find out the preferred work values, environment, interactions, and activities of employees in a Maritime institution. A survey questionnaire was administered to a group of respondents composed of 146 faculty and non-teaching staff who represent the sample size from the total population of 231 employees. Results of the study showed evidence that the employees place the highest value on spirituality, mutual respect, reaching goals, open communication, strong support system, cohesiveness, effective leadership, transparency, and recognition, among others. As a whole, they respond most positively to a fast-paced, result-oriented, and organized work environment. Building from the findings gathered, the study recommends the alignment of the employees’ preferences with the institution’s core values and priorities. Since being recognized for their efforts and contribution is important to them, recognition must be given where and when it is deemed best. It is also recommended that more workshops must be held to provide the employees an opportunity to revisit their value system in relation to themselves and others in the organization. Priorities in relation to work must also be reassessed or redefined through these workshops.

Smarter radiation oncology.

32 Background: The evolution of radiation oncology (RO) has established granular and detailed CPT codes that define the process of care for patients receiving radiation services. And while each of these codes are legitimately and carefully crafted within the relative value system, they nonetheless serve as surrogates for treatment. As health care moves into a value based future, RO is uniquely situated to offer high-value and affordable cancer care. In addition, ASTRO’s ‘safety is no accident’ and other authoritative articles show a high emphasis of structure, a ‘learning curve’ in process but a dearth of direction on outcomes. A truly integrated practice standard for RO has therefore not yet been realized. Methods: Over the last 5-yrs, based on learning from incidents reported in our department and a risk mitigation study, we have reshaped our practice to be based on three measurable aspects – evidence based and consensus driven care pathways, patient experience and quality. By assimilating the cost perspective into this three-tiered matrix, we believe we have created a model for RO that is predictive of value. We summarize facets of this model that embrace structure, process and outcomes aspects of quality that we believe add most value to the care we provide. Results: The elements of Smarter Radiation Oncology (SRO) were determined to be process mapping, standardization of treatment pathways and toxicity grading, incident reporting, pre-treatment peer review planning contour rounds, our no-fly policy, the Kaizen approach to overhead mitigation, an electronic whiteboard for process co-ordination, survivorship, patient perception of care and the Z-score for measuring operational efficiencies. Conclusions: SRO has shown a sustained and substantial level of improvement in many aspects of the care we provide. And while it is designed to allow for the unencumbered freedom to practice RO, we are often times limited by payers who refuse care based on the artificial and differential aspects of complex therapy. We plan to present how SRO improves value by offering less expensive care that can be used as a foundation for a new episodic payment system based on cost. If adopted, the decision process of therapy becomes agnostic of technology and patient focused.

A matrix model for valuing anesthesia service with the resource-based relative value system.

BackgroundThe purpose of this study was to propose a new crosswalk using the resource-based relative value system (RBRVS) that preserves the time unit component of the anesthesia service and disaggregates anesthesia billing into component parts (preoperative evaluation, intraoperative management, and postoperative evaluation). The study was designed as an observational chart and billing data review of current and proposed payments, in the setting of a preoperative holing area, intraoperative suite, and post anesthesia care unit. In total, 1,195 charts of American Society of Anesthesiology (ASA) physical status 1 through 5 patients were reviewed. No direct patient interventions were undertaken.ResultsSpearman correlations between the proposed RBRVS billing matrix payments and the current ASA relative value guide methodology payments were strong (r=0.94–0.96, P<0.001 for training, test, and overall). The proposed RBRVS-based billing matrix yielded payments that were 3.0%±1.34% less than would have been expected from commercial insurers, using standard rates for commercial ASA relative value units and RBRVS relative value units. Compared with current Medicare reimbursement under the ASA relative value guide, reimbursement would almost double when converting to an RBRVS billing model. The greatest increases in Medicare reimbursement between the current system and proposed billing model occurred as anesthetic management complexity increased.ConclusionThe new crosswalk correlates with existing evaluation and management and intensive care medicine codes in an essentially revenue neutral manner when applied to the market-based rates of commercial insurers. The new system more highly values delivery of care to more complex patients undergoing more complex surgery and better represents the true value of anesthetic case management.

Medicare as Insurance Innovator

The stylized fact is that while private insurance has tended to innovate on the benefit design side of the insurance contract, Medicare has lead innovation on the payment side. Traditional or Fee-For-Service Medicare has produced many innovations in the payment for health care services, such as Prospective Payment for hospitals, Diagnostic-Related Groups to categorize care, and the Resource-Based Relative Value System used by the program to pay physicians, while private insurance has produced a series of benefit design innovations. This story misses one important example of Medicare benefit innovation: the creation of the Medicare hospice benefit. A key question is whether Medicare can again lead a system-wide benefit design effort to improve upon current hospice and palliative care policy.

Productivity in Audiology and Speech-Language Pathology

Productivity in Audiology and Speech-Language Pathology

Valuing the Education Mission: Implementing an Educational Value Units System

Valuing the Education Mission: Implementing an Educational Value Units System

Bringing New Technologies to Market: Hurdles and Solutions

Bringing New Technologies to Market: Hurdles and Solutions

건강보험 요양급여비용 계약의 문제점과 개선방안 연구

Korean medical fee contract system between the insurer and healthproviders was introduced in 2000. However, a continuous discord among contracting parties concerned and an irrational operation of an arbitration committee of Ministry for Health, Welfare and Family Affairs (MIHWAF) have made it difficult for them to reach to an agreement over last 8 years. The purpose of this study is to observe the current problems of contract system from the view of health insurance law and actual examples. Furthermore, I examined the of breakdown of negotiation by analyzing the eligibility of contracting parties, rationality of Resource Based Relative Value System (RBRVS) and contracting method and fairness of arbitration method in case of negotiation rupture. The results were as follows: First, since the introduction of medical fee contract system, there has been a problem in that both the president of National Health Insurance Corporation (NHIC) and health care provider association have not held strong negotiation power. Second, the frequent changes and notifications of Relative Value Units (RVUs) without any mutual consent between the insurer and provider association negatively have influenced the conversion factors and finally hindered the agreement of contract. Third, a current process that the conversion factors are mediated and determined at the arbitration committee of MIHWAF in the case of contract breakdown between contracting parties has some flaw in that the irrational composition of committee provoked the lack of fairness and objectivity of mediation. Fourth, we can not prospect a satisfactory outcome of arbitration committee because the mediation always has failed to proceed smoothly due to boycott of both committee members from insurer and providers over last 8 years. As a result, we have to make an every effort to resolve problems mentioned above and then dream of an advanced national health insurance system.

CPT®: An Open System That Describes All That You Do

The American Medical Association, with the cooperation of multiple major medical specialty societies, including the ACR, responded in 1966 to the need for a complete coding system for describing medical procedures and services with the first publication of Current Procedural Terminology (CPT). This system, now CPT IV, forms the basis of reporting of virtually all inpatient and outpatient services performed by physicians and nonphysician health care providers as well as facilities. This coding system and its maintenance process have evolved in complexity and sophistication, particularly in the past decade, such that it is now integral to all facets of health care, including tracking new and investigational procedures and reporting and monitoring performance measures (read "pay for performance"), in addition to its long-standing use for reporting for reimbursement. To paraphrase a recent automobile commercial, "This is not your father's CPT." The author describes the development of CPT as it exists today, examining the forces that molded its current form, the input opportunities available to medical specialty societies and others, the ever increasing transparency of the CPT maintenance process, and the availability of resources allowing all to stay current. Understanding this system, critical to the practice of all of medicine, including radiology, will aid all health care providers in maintaining the quality, efficiency, and accuracy of their practices' business operations as well as assist them in a world of increasingly complex reporting requirements.

Civil society between the state and society: Turkish women with Muslim headscarves?

Issues raised by women in relation to the wearing of Muslim headscarves challenge the assumed democratic rights of citizens and the conditions of distribution of social goods, such as education, in many countries in Europe. These demands to wear headscarves also point to a cleavage in the assumed relationship between state and civil society in democratic systems. By looking at the situation in Turkey, this study questions the priority given to civil society in the analysis of democratic systems as the space for social negotiation through which marginalized voices can participate in the democratic discussions. It is instead argued that in cases where state and the civil society are closely associated and share a similar socio-cultural value system in relation to the broader national identity, then the civil society ‘space’ is in practice very limited. This has serious consequences for both the claims of women in headscarves and for democratic rights in general.

Payer Type Has Little Effect on Operative Rate and Surgeons?? Work Intensity

Does health-care payer type affect the rate of operative treatment and surgeons' work intensity for patients with orthopaedic conditions? We analyzed the clinical and financial data collected during 6 consecutive years (1999-2004) for a group practice of 40 orthopaedic surgeons. We examined the rate of operative treatment and surgeons' work intensity (total physician's work Resource-based Relative Value System units) by diagnosis, patient age, and payer type. The eight payer types were: capitation health maintenance organization, health maintenance organization, preferred provider organization, indemnity, self-pay, Workers' Compensation, Medicaid, and Medicare. There were 230,306 patients with 526 unique primary diagnoses. Diagnosis accounted for most of the variability in operative rates and surgeons' work intensity. After adjusting for differences attributable to diagnosis, payer type had little effect on the rate of operative treatment and surgeons' work intensity.

“What is Best in Life, Conan?”

“To crush your enemies, see them driven before you, and to hear the lamentation of their women.”

Long-term costs of intimate partner violence in a sample of female HMO enrollees

To compare costs associated with intimate partner violence (IPV) overall and for selected physical health problems in a non-poor, privately insured sample. We compared 185 women aged 21-55 who were physically and/or sexually abused between 1989 and 1997 and enrolled in a multisite metropolitan health maintenance organization (HMO) to 198 never abused women enrolled in the same plan who had been matched using propensity score stratification. Costs associated with HMO visits, hospital stays, referrals, and emergency room (ER) visits, prescriptions, and radiology are based on the Medicare Resource-Based Relative Value System, expressed in 2005 dollars. Average health care costs for women who reported physical, sexual, and/or emotional abuse exceeded those of never abused women by $1,700 over the 3-year study period. Women who reported abuse within 12 months of interview had higher average costs, as did women who reported physical abuse; however, sexual or emotional abuse and previous abuse also elevated costs. Costs associated with neurologic symptoms, injuries, mental health care, and unclassified symptoms account for most of these differences. IPV elevates health care costs, not only among women currently experiencing abuse, but also among women for whom the abuse has ceased. Efforts to control health care costs should focus on early detection and prevention of IPV.

TH‐D‐230A‐01: Economics Refresher Course: How Medical Physics Services Are Reimbursed

Medical physics services in medicine are reimbursed through the Current Procedural Terminology (CPT) Codes published by the American Medical Association in an annual publication. Although CPT codes for medical physics services appear explicitly in the radiation oncology series of CPT codes (77XXX), diagnostic radiological physicists may use several of these codes to cover patient specific work they may be called on to perform. This refresher course will trace the advent of the Centers for Medicare and Medicaid Services (CMS) relative value system for reimbursement for medical services and explain in detail how the complex system operates for current and new technology codes. Payments differ in various settings such as hospital, free‐standing center and ambulatory surgical center and these differences will be traced for each site of service.Additionally, private health insurance carrier are not required to follow the precepts of the CPT formalism and these reimbursement entities will be described in their methodology of reimbursement for these services. Finally, ancillary publications that impinge on these reimbursement rules (eg. Correct Coding Initiative, CCI) will be referenced. Coding compliance guides such as those published by ASTRO and ACR will form the basis for this economics refresher course.

Reimbursement risks with radiologist extenders: there is no free lunch!

There is great allure in the concept of using qualified health care providers to assist radiologists and radiation oncologists, increasing efficiency and possibly even improving patient care delivery. However, physician services are most commonly reimbursed under a system that is resource based, and the physician work and practice expense components of reimbursement for existing procedure codes are periodically reexamined to ensure their appropriate rank in this “relative value system.” Also, as new codes are developed, demonstrable physician work and practice expenses will determine the relative values for the new procedures. In both cases, the type of individual who actually performs different portions of a procedure will determine the reimbursement level. In addition, the total reimbursement must be appropriately apportioned between the physician involved and the facility where the service is delivered. This article examines some of the potential impacts on procedure coding and radiologist and radiation oncologist reimbursement schedules if physician extenders perform work previously performed by physicians. It also examines possible shifts in reimbursement from physician to facility if an extender is employed by a facility.