Committee Representation and Medicare Reimbursements-An Examination of the Resource-Based Relative Value Scale.

ABSTRACT: BACKGROUND:The Resource-Based Relative Value Scale Update Committee (RUC) submits recommended reimbursement values for physician work (wRVUs) under Medicare Part B. The RUC includes rotating representatives from medical specialties. OBJECTIVE:To identify changes in physician reimbursements associated with RUC rotating seat representation. DATA SOURCES:Relative Value Scale Update Committee members 1994-2013; Medicare Part B Relative Value Scale 1994-2013; Physician/Supplier Procedure Summary Master File 2007; Part B National Summary Data File 2000-2011. STUDY DESIGN:I match service and procedure codes to specialties using 2007 Medicare billing data. Subsequently, I model wRVUs as a function of RUC rotating committee representation and level of code specialization. PRINCIPAL FINDINGS:An annual RUC rotating seat membership is associated with a statistically significant 3-5 percent increase in Medicare expenditures for codes billed to that specialty. For codes that are performed by a small number of physicians, the association between reimbursement and rotating subspecialty representation is positive, 0.177 (SE = 0.024). For codes that are performed by a large number of physicians, the association is negative, -0.183 (SE = 0.026). CONCLUSIONS:Rotating representation on the RUC is correlated with overall reimbursement rates. The resulting differential changes may exacerbate existing reimbursement discrepancies between generalist and specialist practitioners.

SUBMITTER: Gao YN 

PROVIDER: S-EPMC6232394 | biostudies-literature | 2018 Dec

REPOSITORIES: biostudies-literature