Lotan Yair, Cadeddu Jeffrey A, Roehrborn Claus G, Stage Key H
Department of Urology, The University of Texas Southwestern Medical Center, Dallas, Texas 75390, USA.
J Urol. 2004 Nov;172(5 Pt 1):1958-62. doi: 10.1097/01.ju.0000142016.51680.fa.
Several reforms to Medicare have changed the reimbursement of physicians from payment based on usual, customary or reasonable charges to a resource based relative value scale. We studied the effect of these changes on hourly reimbursement rates for various services provided by urologists.
We used a previously published national survey of urologists who provided information regarding physician time and work required before, during and after most frequently performed urological services, including during the global period. For comparison mean operative times during the last year at our private hospital for several common urological procedures were obtained. Medicare reimbursement rates for common urological procedures and evaluation and management (E&M) codes for 1995, 1999 and 2004 were acquired from our department's billing office and used to calculate reimbursement rate per hour.
There was a steady increase in reimbursement for outpatient services and a decrease in reimbursement for surgical procedures. For E&M codes the reimbursement rates per hour for 2004 represent a mean 51% increase since 1995. However, surgical procedures have had a mean decrease of 28.5% in reimbursement rates per hour. There was remarkable consistency in rates with 7 of the 9 surgical procedures losing between 25.5% and 32% in reimbursement. In 1995 outpatient E&M services were the least profitable at less than half the hourly rate of operative procedures. In 2004 office cystoscopy and transrectal ultrasound biopsy of the prostate had the highest reimbursement and, with the exception of shock wave lithotripsy, there was a minimal difference in hourly reimbursement rates between common surgical procedures and E&M services.
Changes in Medicare reimbursement during the last decade have resulted in significant changes in rates for different urological services. The near equity in reimbursement rates for E&M and surgical services will likely have an increasingly important role in the future practice of urology.
医疗保险的多项改革已将医生的报销方式从基于通常、惯例或合理收费转变为基于资源的相对价值尺度。我们研究了这些变化对泌尿科医生提供的各种服务每小时报销率的影响。
我们使用了之前发表的一项针对泌尿科医生的全国性调查，这些医生提供了有关最常进行的泌尿科服务之前、期间和之后（包括在全程包干期间）所需的医生时间和工作量的信息。为作比较，获取了我们私立医院去年几种常见泌尿科手术的平均手术时间。1995年、1999年和2004年常见泌尿科手术及评估与管理（E&M）代码的医疗保险报销率从我们科室的计费办公室获取，并用于计算每小时报销率。
门诊服务的报销稳步增加，而手术程序的报销减少。对于E&M代码，2004年每小时的报销率自1995年以来平均增长了51%。然而，手术程序每小时的报销率平均下降了28.5%。报销率具有显著的一致性，9种手术程序中有7种的报销率下降了25.5%至32%。1995年门诊E&M服务的盈利最少，每小时费率不到手术程序的一半。2004年，办公室膀胱镜检查和前列腺经直肠超声活检的报销率最高，除冲击波碎石术外，常见手术程序和E&M服务每小时的报销率差异最小。
过去十年医疗保险报销的变化导致不同泌尿科服务的报销率发生了显著变化。E&M和手术服务报销率的接近公平在未来的泌尿科实践中可能会发挥越来越重要的作用。
