Practice Expense Methodology and Data Collection Research and Analysis

Burgette, Lane F.; Liu, Jodi L.; Miller, Benjamin M.; Wynn, Barbara O.; Dellva, Stephanie; Malsberger, Rosalie; Merrell, Katie; Nguyen, PhuongGiang; Nie, Xiaoyu; Pane, Joseph D.; Qureshi, Nabeel; Ruder, Teague; Zhao, Lan; Hussey, Peter S.

doi:10.7249/rr2166

Cited by 3 publications

(10 citation statements)

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“…These "practice expenses" make up a substantial fraction of current payments; indeed, in Medicare's fee-schedule, practice expenses represent 45% of all payments to providers. 51 Many alternative telehealth offerings have sought other ways of making care more efficient as well. For example, relying more on lower-cost unlicensed providers or information technology, such as remote patient monitoring or digital therapeutics, reduces the labor costs necessary to care for a given patient.…”

Section: How Much Should Be Paid For Telehealth Services and Should T...mentioning

confidence: 99%

How Emerging Telehealth Models Challenge Policymaking

Tang¹,

Chernew

Mehrotra

2022

Milbank Quarterly

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Current telehealth policy discussions are focused on synchronous video and audio telehealth visits delivered by traditional providers and have neglected the growing number of alternative telehealth offerings. These alternative telehealth offerings range from simply supporting traditional brick‐and‐mortar providers to telehealth‐only companies that directly compete with them. We describe policy challenges across this range of alternative telehealth offerings in terms of using the appropriate payment model, determining the payment amount, and ensuring the quality of care.

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Section: How Much Should Be Paid For Telehealth Services and Should T...mentioning

confidence: 99%

How Emerging Telehealth Models Challenge Policymaking

Tang¹,

Chernew

Mehrotra

2022

Milbank Quarterly

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“…First, we consider how updated PE data could be collected through a new survey effort. In the previous phase of this line of research, Phase I, reported in Burgette et al, 2018, we found that no existing data sources would be acceptable replacements for the PPI Survey data. CMS asked us to evaluate how a survey-based collection effort could be designed and administered to replace the PPI as a source of data inputs.…”

Section: Discussionmentioning

confidence: 95%

“…This chapter summarizes the purpose of this study, provides an overview of the Medicare Physician Fee Schedule (MPFS), and describes how rates are set for the practice expense (PE) component of payments for services in the MPFS. The study has been divided into phases, with Phase I already having been completed, as described in Burgette et al, 2018. This report provides interim results of Phase II of the study and describes next steps for some analyses that will be included in the Phase II final report. This chapter includes background information and findings from the Phase I report, describes the Phase II study objectives and how the results might be used, and explains the organization of the remainder of the report.…”

Section: Overviewmentioning

confidence: 99%

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Practice Expense Methodology and Data Collection Research and Analysis: Interim Phase II Report

Burgette¹,

Cohen²,

Hero³

et al. 2020

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Limited Print and Electronic Distribution RightsThis document and trademark(s) contained herein are protected by law. This representation of RAND intellectual property is provided for noncommercial use only. Unauthorized posting of this publication online is prohibited. Permission is given to duplicate this document for personal use only, as long as it is unaltered and complete. Permission is required from RAND to reproduce, or reuse in another form, any of its research documents for commercial use. For information on reprint and linking permissions, please visit www.rand.org/pubs/permissions.The RAND Corporation is a research organization that develops solutions to public policy challenges to help make communities throughout the world safer and more secure, healthier and more prosperous. RAND is nonprofit, nonpartisan, and committed to the public interest. RAND's publications do not necessarily reflect the opinions of its research clients and sponsors.

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“…31 For a discussion of the challenges with the reverse building-block and magnitude-estimation approaches, see Wynn et al, 2015. 32 For a detailed overview of PE methodology, see Zuckerman et al, 2015, andBurgette et al, 2018. Post-operative visits therefore contribute to PE RVUs through the following four channels:…”

Section: Pementioning

confidence: 99%

Using Claims-Based Estimates of Post-Operative Visits to Revalue Procedures with 10- and 90-Day Global Periods: Updated Results Using Calendar Year 2019 Data

Mulcahy¹,

Ruder²,

Lovejoy³

et al. 2021

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Medicare payment for many surgical procedures covers not only the procedure itself but also post-operative care provided by the same practitioner over a fixed period of time (the "global period"). When the Centers for Medicare & Medicaid Services (CMS) sets the payment rate for a given procedure, it assumes that a certain number of post-operative visits will typically occur during the global period. In other research (Kranz et al., 2021; Crespin et al., forthcoming-a; Crespin et al., forthcoming-b), RAND Corporation researchers found that the number of visits actually performed was lower than the number that CMS assumes to occur when setting payment rates. In a prior report (Mulcahy, Liu, et al., 2021), we described how new claims-based data on the number of post-operative visits could be used to adjust the valuation of procedures with 10and 90-day global periods. In this report, we update our analysis using 2019 claims-based data. These results may inform further policy development around revaluation for global procedures.This research was funded by CMS (HHSM-500-2014-00036I) and carried out within the Payment, Cost, and Coverage Program in RAND Health Care.RAND Health Care, a division of the RAND Corporation, promotes healthier societies by improving health care systems in the United States and other countries. We do this by providing health care decisionmakers, practitioners, and consumers with actionable, rigorous, objective evidence to support their most complex decisions. For more information, see www.rand.org/health-care, or contact

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Practice Expense Methodology and Data Collection Research and Analysis

Cited by 3 publications

References 0 publications

How Emerging Telehealth Models Challenge Policymaking

How Emerging Telehealth Models Challenge Policymaking

Practice Expense Methodology and Data Collection Research and Analysis: Interim Phase II Report

Using Claims-Based Estimates of Post-Operative Visits to Revalue Procedures with 10- and 90-Day Global Periods: Updated Results Using Calendar Year 2019 Data

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