Assessing the viability of all-payer systems for physician services : final report

446 Pages·1997·12.6 MB·English

by  Zuckerman, Stephen

1
50272-101 RZc'e):
REPORTDOCUMENTATION 1.ReportNo. 2. 3. Recipient'sAccession No.
PAGE
4.TitleandSubtitle 5. ReportDate
Assessing the Viability ofAll-Payer Systems for Physician Services May, 1996
6.
7.Author(s) 8. PerformingOrganization Rept. No.
Stephen Zuckerman, Diana K. Verrilli, Stephen A. Norton
9. PerformingOrganization NameandAddress 10. Project/Task/Work UnitNo.
The Urban Institute
2100 M Street, N.W. 11.Contract(C)orGrant(G) No.
Washington, D.c. 20037 (C) 5UU-y2-UU24
(G)
12.SponsoringOrganization NameandAddress 13. TypeofReport& PeriodCovered
Health Care Financing Administration Final Report
Office of Research and Demonstrations
7500 Secunty Blvd., Mail Stop C3-20-1 14
Baltimore, MD 21244-1850
15.SupplementaryNotes
16.Abstract(Limit: 200words)
This report focuses on the impact of establishing a payment structure for physician services that could be used
in conjunction with varoius approcahes to cost containments. To that end, it investigates the Medicare Fee
Schedule and its potential impact on private payers and Medicaid and the development of an all payment
physician rate system for states.
17.DocumentAnalysis a.Descriptors
Medicare Fee Scheule
Medicaid
b. Identifiers/OpenEndedTerms
c.COSATI Field/Group
18.AvailabilityStatement 19. SecurityClass(This Report) 21 No. ofPages
.
Unclassified approx 150
NTIS Release Unlimited 20.SecurityClass(This Page) 22. Price
Unclassified
OPTIONALFORM 272(4-77)
(Formerly NTIS-35)
DepartmentofCommerce

FINAL REPORT
06375-01-06 May 1996
ASSESSING THE VIABILITY OF ALL-PAYER
SYSTEMS FOR PHYSICIAN SERVICES
Stephen Zuckerman
Diana K. Verrilli
Stephen A. Norton
The Urban Institute
M
2100 Street, N.W.
Washington, D.C. 20037
Support for this research provided by Health Care Financing Administration Contract No. 500-
92-0024. Conclusions and opinions expressed in this paper are solely those ofthe authors and do
not necessarily reflect the views ofthe Urban Institute or the Health Care Financing
Administration and its sponsors.
The authors wish to acknowledge our HCFA Project Officer, Jesse Levy, for useful guidance
provided throughout this study and J. Joseph McGoldrick for his programming assistance and the
private insurance payers who provided data for the analysis.

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TABLE OF CONTENTS
INTRODUCTION
I. 1.1
REFERENCES Ill
THE MEDICARE RELATIVE VALUE SCALE AND PRIVATE PAYERS: THE
E.
POTENTIAL IMPACT ON PHYSICIAN PAYMENTS
1.1
INTRODUCTION
A. II.1
B. DATA SOURCES H.3
METHODS
C. 11.10
D. NATIONAL RESULTS 11.18
STATE-LEVEL RESULTS
E. 11.20
DISCUSSION
F. 11.27
REFERENCES
11.29
m. DEVELOPING ALL-PAYMENT PHYSICIAN RATES FOR STATES
III.1
INTRODUCTION
A. III.l
DATA AND METHODS
B. III.2
RESULTS
C. III.4
CONCLUSIONS
D. III.
IV. PREFERRED PROVIDER ORGANIZATIONS AND PHYSICIAN FEES V.
1
A. INTRODUCTION IV.1
DATA AND METHODS
B. IV.4
C. DISCUSSION IV.12
REFERENCES
IV.15
V. MEDICAID PHYSICIAN PAYMENT: CURRENT POLICIES AND THE POTENTIAL
IMPACT OF THE MADICARE RELATIVE VALUE SCALE
VI.1
BACKGROUND
A. V.l
B. DATA AND METHODS V.4
C. RESULTS V.ll
D. DISCUSSION V.21
REFERENCES V.24

VI. THE GAP BETWEEN MEDICAID FEES AND THE MEDICARE FEE SCHEDULE
(MFS): RESULTS OF A 1993 MEDICAID FEE SURVEY VI.
1
A. INTRODUCTION VI.
1
DATA COLLECTION AND METHODS
B. VI.3
C. RESULTS VI.7
CONCLUSIONS
D. VI.13
REFERENCES
VI.17
APPENDIX A: Estimating RVUs for Physician Services A.1
APPENDIX B: The Process Used to Crosswalk 1990 Service Codes to a Clinically Equivalent
1993 Service Code B.l
APPENDDC C: 1993 Urban Institute Fee Survey: Medicaid Fees by State C.l
APPENDDX D: Medicaid Payment Policy Survey Instrument D.
1
APPENDDC E: Estimating RVUs for Physician Services E.1