Obstet Gynecol. 2024 Feb 1;143(2):e40-e53. doi: 10.1097/AOG.0000000000005487.
To perform an environmental scan of the current status of reimbursement for obstetric and gynecology services and identify problematic issues and opportunities for change. The areas that were evaluated include the American Medical Association (AMA) relative value unit assignment process, payer rates (where available), and trends in employment and salary determination for obstetrician-gynecologists (ob-gyns).
This report was developed by members of the American College of Obstetricians and Gynecologists' (ACOG) Committee on Health Economics and Coding using public-facing payment data from the Medicare Physician Fee Schedule and state Medicaid programs, as well as published research and commentary on payment for physicians, maternal health, and gynecologic surgery. Data from the Centers for Disease Control and Prevention were used to describe typical patient characteristics, and practice survey reports from the AMA were analyzed. Finally, an anonymous online survey was distributed to 27,854 members of ACOG in March 2022, with a response rate of 10.8% (3,018 members) and a CI of ±1.7%.
The evaluation found that payment for ob-gyns is heavily influenced by the values and rates set by third-party payers, a patient case-mix that includes a higher-than-average number of patients with Medicaid insurance, and the increase of employed physicians reliant on salary contracts that include productivity requirements and bonuses.
The Committee identified action items, including payment reform for obstetric services; advocating for gynecologic surgery time as a priority for hospital administration; developing resources to assist employed physicians with payment, practice, and business management; developing a business and coding curriculum for students and early-career physicians; and continued advocacy with private and public policymakers who influence physician payment.
对妇产科服务报销的现状进行环境扫描，确定存在的问题和变革机会。评估的领域包括美国医学协会（AMA）相对价值单位分配过程、支付者费率（如有），以及妇产科医生就业和薪酬趋势。
本报告由美国妇产科医师学会（ACOG）健康经济学和编码委员会的成员编写，使用了医疗保险医师费用表和州医疗补助计划的公开支付数据，以及关于医生薪酬、孕产妇健康和妇科手术支付的已发表研究和评论。疾病控制与预防中心的数据用于描述典型的患者特征，分析了 AMA 的实践调查报告。最后，于 2022 年 3 月向 ACOG 的 27854 名成员分发了匿名在线调查，回复率为 10.8%（3018 名成员），置信区间为±1.7%。
评估发现，妇产科医生的薪酬受到第三方支付者的价值观和费率、包括 Medicaid 保险患者比例较高的患者组合，以及依赖包含生产力要求和奖金的薪酬合同的受雇医生增加的严重影响。
委员会确定了行动项目，包括对产科服务进行支付改革；倡导将妇科手术时间作为医院管理的优先事项；开发资源，帮助受雇医生进行支付、实践和业务管理；为学生和早期职业医生开发业务和编码课程；并继续与影响医生薪酬的私人和公共政策制定者进行倡导。
