Estimating Physicians' Work for a Resource-Based Relative-Value Scale

Hsiao, William C.; Braun, Peter; Yntema, Douwe B.; Becker, Edmund R.

doi:10.1056/nejm198809293191305

Cited by 324 publications

(143 citation statements)

References 8 publications

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“…Relative value units are units of value assigned to each medical procedure based on the resources (labor, capital equipment, office space, etc) used to produce that procedure. One of the most popular RVU scales is the Resource Based Relative Value Scale (RBRVS) developed by Hsiao and colleagues 14 which serves as the basis for Medicare Part B reimbursement of physicians. RVUs are translated into prices or costs by multiplying by a dollar conversion factor.…”

Section: Methods Of Data Collectionmentioning

confidence: 99%

Economic analyses of bone marrow and blood stem cell transplantation for leukemias and lymphoma: what do we know?

Waters

Bennett

Pajeau³

et al. 1998

Bone Marrow Transplant

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Summary:The use of blood and/or bone marrow stem cell transplantation (SCT) grew extensively in the last decade as technological advances led to improved outcomes and wider availability. The first study of SCT costs, however, was not published until 1989. This paper summarizes current knowledge about costs and cost-effectiveness of allogeneic and autologous SCT for leukemias and lymphoma. Methodological issues in cost studies such as types of costs, methods of data collection, and time horizons are discussed, and studies are evaluated with regard to these issues. Considerations specific to economic analyses of SCT are considered, including the potential impact of technological changes, learning curve effects, and inter-institutional differences. Keywords: cost-effectiveness, economics, stem cell transplantation The field of blood and bone marrow transplantation (stem cell transplantation, SCT) has changed dramatically over the past 10 years. Major advances in SCT technology has led to improved outcomes and wider availability. Numbers of SCT have increased from less than 5000 to more than 40 000 annually, and hundreds of papers related to SCT have been published.1 Yet relatively few studies have addressed the costs and cost-effectiveness of this complex technology, although perceived high costs contribute to the controversy over its use.The first comprehensive study of the costs of SCT was reported in 1989 and indicated that, while allogeneic bone marrow transplantation for patients with acute myelogenous leukemia (AML) was very costly, it was more cost-effective than chemotherapy.2 In the past 3 years, with physicians facing increased economic pressures in the United States and abroad, many more studies have included economic analyses. These studies report markedly lower costs of SCT than in 1989 and even more favorable cost-effectiveness profiles for persons with hematological malignancies. In this paper, we provide an overview of economic analyses in general and subsequently summarize studies of costs of SCTs for leukemia and lymphoma.Because the studies we review were conducted utilizing various methodologies and make numerous, differing assumptions regarding cost and clinical parameters, we begin our paper with a proposed framework for reviewing cost analyses (Section 1). We then review some of the 'issues' that our framework highlights, based on the work of others in the field (Section 2).3-8 Section 3 begins with a table summarizing the current literature on costs of SCT using the framework developed in Section 1. Section 3 also discusses the more current, well-designed/presented studies, highlighting the authors' conclusions. Section 4 presents some additional issues to be considered in cost analyses of SCT. A framework for comparing cost studiesThere is growing attention to the costs and cost-effectiveness of medical interventions. Review of the sizable body of literature devoted to the topic reveals conflicting definitions of cost as well as discrepant methods for conducting and reporting studies. The w...

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Section: Methods Of Data Collectionmentioning

confidence: 99%

Economic analyses of bone marrow and blood stem cell transplantation for leukemias and lymphoma: what do we know?

Waters

Bennett

Pajeau³

et al. 1998

Bone Marrow Transplant

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“…Outpatient and inpatient costs were estimated using a relative value units (RVUs) methodology, 24 where costs were calculated by applying unit costs assigned to each medical service item to each patient's resource utilization, and were adjusted for inflation to the year 2004 (US dollars), using the medical care component of the consumer price index. 25 Days of hospitalization, with dates of admission to 1 year post-transplant and the number of outpatient clinic visits through 1 year post-transplant, were also obtained to interpret cost data.…”

Section: Data Collectionmentioning

confidence: 99%

Lower costs associated with hematopoietic cell transplantation using reduced intensity vs high-dose regimens for hematological malignancy

Saito

Zahrieh

Cutler

et al. 2007

Bone Marrow Transplant

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We compared inpatient and outpatient costs alongside clinical outcomes associated with hematopoietic cell transplantation between 2000 and 2003 with high-dose regimens (HDCT, n ¼ 185) and with reduced intensity regimens (RICT, n ¼ 90) from human leukocyte antigen (HLA)-matched donors for patients with hematological malignancies. With a comparable median follow-up of 3 years, long-term clinical outcomes, including cumulative incidence of chronic graft-vs-host disease, disease-free survival and overall survival, were similar between the two groups. In the univariate analysis, median costs for the first 100 days ($104 380 vs $42 149) and 1 year ($128 253 vs $80 499) in the HDCT group were higher than those in the RICT group. Median days of hospitalization are also higher for HDCT recipients (39 vs 21), although the number of outpatient clinic visits for HDCT recipients were fewer compared to that for RICT recipients (16 vs 25) during the first year. Adjusting for patient characteristics, RICT recipients had approximately 16 fewer days of hospitalization and cost $53 030 less than HDCT recipients within the first year after transplantation. Our data suggest that substantially lower costs and fewer days of hospitalization within the first year after RICT procedures can be obtained with no compromise of longterm clinical outcomes compared to HDCT procedures.

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“…For example, the Resource-Based Relative Value Scale, instituted by Medicare in 1992, assigned relative value units (RVUs) for each service provided, based on a formula of physician work, practice costs, and the cost of specialty training. This effort reflected an attempt to standardize Medicare payments to physicians [2], and many other payers followed Medicare's lead. Despite this attempt at standardization, however, income disparities between specialists and generalists have persisted for a variety of reasons, including increasing volume of procedures and weaknesses and political pressures within the Relative Value Scale update process that continue to favor the status quo [3].…”

Section: Medical Payments In the Usmentioning

confidence: 99%