Jacobs Jeffrey P, Lahey Stephen J, Nichols Francis C, Levett James M, Johnston George Gilbert, Freeman Richard K, St Louis James D, Painter Julie, Yohe Courtney, Wright Cameron D, Kanter Kirk R, Mayer John E, Naunheim Keith S, Rich Jeffrey B, Bavaria Joseph E
Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland; Division of Cardiovascular Surgery, Department of Surgery, Johns Hopkins All Children's Heart Institute, Johns Hopkins All Children's Hospital and Florida Hospital for Children, Saint Petersburg, Tampa, and Orlando, Florida.
Division of Cardiothoracic Surgery, Department of Surgery, University of Connecticut School of Medicine, Farmington, Connecticut.
Ann Thorac Surg. 2017 Feb;103(2):373-380. doi: 10.1016/j.athoracsur.2016.11.059.
Strategies to value physician work continue to evolve. The Society of Thoracic Surgeons and The Society of Thoracic Surgeons National Database have an increasingly important role in this evolution. An understanding of the Current Procedural Terminology (CPT) system (American Medical Association [AMA], Chicago, IL) and the Relative Value Scale Update Committee (RUC) is necessary to comprehend how physician work is valued. In 1965, with the dawn of increasingly complex medical care, immense innovation, and the rollout of Medicare, the need for a common language describing medical services and procedures was recognized as being of critical importance. In 1966, the AMA, in cooperation with multiple major medical specialty societies, developed the CPT system, which is a coding system for the description of medical procedures and medical services. The RUC was created by the AMA in response to the passage of the Omnibus Budget Reconciliation Act of 1989, legislation of the United States of America Federal government that mandated that the Centers for Medicare & Medicaid Services adopt a relative value methodology for Medicare physician payment. The role of the RUC is to develop relative value recommendations for the Centers for Medicare & Medicaid Services. These recommendations include relative value recommendations for new procedures or services and also updates to relative value recommendations for previously valued procedures or services. These recommendations pertain to all physician work delivered to Medicare beneficiaries and propose relative values for all physician services, including updates to those based on the original resource-based relative value scale developed by Hsaio and colleagues. In so doing, widely differing work and services provided can be reviewed and comparisons of their relative value (to each other) can be established. The resource-based relative value scale assigns value to physician services using relative value units (RVUs), which consist of three components: work RVU, practice expense RVU, and malpractice RVU, also known as professional liability insurance RVU. The Centers for Medicare & Medicaid Services retains the final decision-making authority on the RVUs associated with each procedure or service. The purpose of this article is to discuss the role that the CPT codes and the RUC play in the valuation of physician work and to provide an example of how the methodology for valuation of physician work continues to evolve.
评估医生工作价值的策略不断发展。胸外科医师协会及其国家数据库在这一发展过程中发挥着越来越重要的作用。要理解医生工作价值的评估方式，就必须了解现行程序术语（CPT）系统（美国医学协会[AMA]，伊利诺伊州芝加哥）和相对价值尺度更新委员会（RUC）。1965年，随着医疗护理日益复杂、创新不断涌现以及医疗保险的推出，人们认识到需要一种描述医疗服务和程序的通用语言至关重要。1966年，AMA与多个主要医学专业协会合作开发了CPT系统，这是一个用于描述医疗程序和医疗服务的编码系统。RUC由AMA设立，以应对1989年《综合预算协调法案》的通过，该法案是美国联邦政府的一项立法，要求医疗保险和医疗补助服务中心采用相对价值方法来支付医疗保险医生的费用。RUC的作用是为医疗保险和医疗补助服务中心制定相对价值建议。这些建议包括针对新程序或服务的相对价值建议，以及对先前评估过的程序或服务的相对价值建议的更新。这些建议适用于向医疗保险受益人提供的所有医生工作，并为所有医生服务提出相对价值，包括对基于Hsiao及其同事最初开发的基于资源的相对价值尺度的那些服务的更新。这样一来，就可以对广泛不同的工作和提供的服务进行审查，并确定它们（相互之间）的相对价值比较。基于资源的相对价值尺度使用相对价值单位（RVU）来为医生服务赋值，相对价值单位由三个部分组成：工作RVU、实践费用RVU和医疗事故RVU，也称为职业责任保险RVU。医疗保险和医疗补助服务中心对与每个程序或服务相关的RVU保留最终决策权。本文的目的是讨论CPT编码和RUC在医生工作价值评估中所起的作用，并举例说明医生工作价值评估方法是如何持续发展的。
