Wynn Barbara O, Burgette Lane F, Mulcahy Andrew W, Okeke Edward N, Brantley Ian, Iyer Neema, Ruder Teague, Mehrotra Ateev
Rand Health Q. 2015 Jul 15;5(1):5.
The Centers for Medicare & Medicaid Services (CMS) uses the resource-based relative value scale to pay physicians and other practitioners for professional services. The work values measure the relative levels of professional time and intensity (physical effort, skills, and stress) associated with providing services. CMS asked RAND to develop a model to validate the work values using external data sources. RAND's goal was to test the feasibility of using external data and regression analysis to create prediction models to validate work values. Data availability limited the models to surgical procedures and selected medical procedures typically performed in an operating room. Key findings from the study include the following: RAND estimates of intra-service time using external data are typically shorter than the current CMS estimates. Model assumptions about how shorter intra-service times affect procedure intensity have implications for the work estimates. RAND estimates for work on average were similar to current work values if shorter intra-service time is assumed to increase procedure intensity and were on average up to 10 percent lower than current work values if shorter intra-service time is assumed to not impact on procedure intensity. The RAND estimates could be used for two key applications: CMS could flag codes as potentially misvalued if the RAND estimates are notably different from the current CMS values. CMS could also use the RAND estimates as an independent estimate of the work values. In some cases, further review will identify a clinical rationale for why a code is valued differently than the RAND model predictions.
医疗保险和医疗补助服务中心（CMS）使用基于资源的相对价值尺度来向医生和其他从业者支付专业服务费用。工作价值衡量与提供服务相关的专业时间和强度（体力消耗、技能和压力）的相对水平。CMS要求兰德公司开发一个模型，使用外部数据源来验证工作价值。兰德公司的目标是测试使用外部数据和回归分析创建预测模型以验证工作价值的可行性。数据可用性将模型限制在外科手术和通常在手术室进行的特定医疗程序上。该研究的主要发现包括：兰德公司使用外部数据对服务内时间的估计通常比CMS目前的估计短。关于较短的服务内时间如何影响程序强度的模型假设对工作估计有影响。如果假设较短的服务内时间会增加程序强度，兰德公司对工作的平均估计与当前工作价值相似；如果假设较短的服务内时间不会影响程序强度，兰德公司的平均估计比当前工作价值低10%。兰德公司的估计可用于两个关键应用：如果兰德公司的估计与CMS当前值明显不同，CMS可以将代码标记为可能估值错误。CMS还可以将兰德公司的估计用作工作价值的独立估计。在某些情况下，进一步审查将确定一个代码与兰德模型预测估值不同的临床理由。
