Dunn D L, Becker E R
Department of Health Policy and Management, Harvard University School of Public Health, Cambridge, MA 02138, USA.
Med Care. 1995 Oct;33(10):975-87. doi: 10.1097/00005650-199510000-00001.
In 1992, Medicare changed significantly how it paid physicians: instead of basing payment rates on charges, the federal government established a fee schedule based on the Resource-Based Relative Value Scale (RBRVS). Central to the development of the RBRVS was the methodology used to align the work of all specialties onto a single, common scale, termed "cross-specialty alignment." This article presents the methods and results of an alternative approach to cross-specialty alignment. We surveyed physicians who were board certified in both pathology and internal medicine (double-boarded) and asked them about the work of services in both specialties. The results provide a natural bridge between the work of the two specialties. The double-boarded survey results agreed closely with the RBRVS findings. Furthermore, the findings were robust after weighting the estimates by how frequently a physician performs a service or after grouping the physicians by the mix of services in their practice. We conclude that the relative work positions of pathology and internal medicine in the RBRVS have validity. Our findings suggest that a survey of physicians with expertise in multiple specialties is a useful approach for developing cross-specialty linkages for an RBRVS or for validating existing linkages.
1992年，医疗保险在支付医生费用的方式上发生了重大变化：联邦政府不再根据收费来确定支付率，而是基于资源相对价值比例（RBRVS）制定了费用表。RBRVS发展的核心是用于将所有专科的工作调整到一个单一通用量表上的方法，即“跨专科调整”。本文介绍了一种跨专科调整的替代方法及其结果。我们对同时拥有病理学和内科专业认证（双认证）的医生进行了调查，并询问他们两个专业服务的工作情况。结果在两个专业的工作之间搭建了一座天然的桥梁。双认证医生的调查结果与RBRVS的结果非常吻合。此外，在根据医生执行某项服务的频率对估计值进行加权后，或者在根据医生执业中服务的组合对医生进行分组后，研究结果依然可靠。我们得出结论，病理学和内科在RBRVS中的相对工作定位是有效的。我们的研究结果表明，对具有多个专科专业知识的医生进行调查，是为RBRVS建立跨专科联系或验证现有联系的一种有用方法。
