Egdahl R H, Hertenstein R D
Ann Surg. 1987 Sep;206(3):349-57. doi: 10.1097/00000658-198709000-00013.
This paper describes the system used by Caterpillar Corporation (CAT) in Peoria, Illinois, to reimburse surgeons. The CAT system assures access for Caterpillar employees and their families to a selection of qualified surgeons, while achieving cost savings through improvements in processing of surgical claims and negotiation of selected fees. CPT-4 codes are recorded for greater accuracy, when indicated, surgical services that have been incorrectly unbundled are rebundled, and the appropriateness of surgical assistant charges is reviewed. A "degree of difficulty" relative value scale (DODRVS) of surgical services is periodically revised as technology changes. The DODRVS multiplied by a regional factor, determined by local market research, establishes the fee that CAT will pay the surgeon. Balance billing is permitted if the patient (1) is informed in advance by the surgeon that the fee will be higher than CAT will pay, and (2) knows that the service can be obtained from other local surgeons who will accept the CAT fee. The goal of the CAT method of surgeon reimbursement is to gain physician support for an access-oriented, market-driven negotiated fee schedule. Compared with a resource-based relative value scale RBRVS) methodology, the CAT system is not formula-driven and depends on physician acceptance.
本文介绍了伊利诺伊州皮奥里亚的卡特彼勒公司（CAT）用于向外科医生支付费用的系统。CAT系统确保卡特彼勒员工及其家属能够选择合格的外科医生，同时通过改进手术费用报销流程和协商特定费用来实现成本节约。在需要时记录CPT - 4代码以提高准确性，对错误拆分的手术服务进行重新合并，并审查手术助理收费的合理性。随着技术的变化，会定期修订手术服务的“难度程度”相对价值量表（DODRVS）。DODRVS乘以由当地市场研究确定的区域因素，确定CAT将支付给外科医生的费用。如果患者（1）事先得到外科医生通知，知晓费用将高于CAT所支付的金额，并且（2）知道可以从接受CAT费用的其他当地外科医生那里获得该服务，则允许差额收费。CAT向外科医生支付费用的方法的目标是获得医生对以获取服务为导向、市场驱动的协商收费表的支持。与基于资源的相对价值量表（RBRVS）方法相比，CAT系统不是公式驱动的，而是依赖于医生的接受程度。
