Kahan J P, Morton S C, Farris H H, Kominski G F, Donovan A J
RAND, Santa Monica, CA.
Med Care. 1994 Nov;32(11):1069-85. doi: 10.1097/00005650-199411000-00001.
In this study, a set of meetings was conducted to pilot a group-discussion-based method anchored by a reference set of services with agreed-on values for revising the Medicare Resource-Based Relative Value Scale (RBRVS). The authors focused on the method as it evolved over the sequence of meetings, rather than on whether the relative values of work obtained were more or less valid than relative values of work obtained elsewhere. Four pilot panels, composed of 46 physicians from different specialties (including primary care), were conducted to rate total physician work. One panel examined 80 urologic services, another panel examined 80 ophthalmologic services, and the last two panels considered the merit of appeals from five specialty and subspecialty societies to 68 and 48 services, respectively. Rather than using the method of ratio estimation relative to a standard service, panelists were asked to estimate magnitudes relative to an established multispecialty reference set of values. Prominent members of that reference set were graphically displayed to panelists on a "ruler." Measures included physicians' preliminary and final ratings and detailed notes of the group discussions conducted between the ratings. The authors found that a panel process for refining relative values of work is practical, provided that panelists are provided with a valid reference set for comparison purposes and provided that care is taken that all members feel comfortable engaging in the discussion. In Summer 1992, the Health Care Financing Association conducted a series of multispecialty panels based on the methods presented here to produce the 1993 RBRVS; in addition, the RBRVS Update Committee of the American Medical Association is employing group processes and a reference set in determining the relative work values of new Current Procedural Terminology codes.
在本研究中，举办了一系列会议，以试行一种基于小组讨论的方法，该方法以一套具有商定价值的参考服务为基础，用于修订医疗保险基于资源的相对价值比例（RBRVS）。作者关注的是该方法在一系列会议中的演变，而非所获得的工作相对价值是否比其他地方获得的工作相对价值更有效或更无效。组建了四个由来自不同专业（包括初级保健）的46名医生组成的试点小组，对医生的总工作量进行评分。一个小组审查了80项泌尿科服务，另一个小组审查了80项眼科服务，最后两个小组分别审议了五个专科和亚专科协会对68项和48项服务提出的上诉的价值。小组成员不是使用相对于标准服务的比率估计方法，而是被要求相对于一套既定的多专科参考价值来估计数量。该参考价值集的突出成员以图形方式在“标尺”上向小组成员展示。测量指标包括医生的初步和最终评分以及评分之间进行的小组讨论的详细记录。作者发现，完善工作相对价值的小组流程是可行的，前提是为小组成员提供一个有效的参考集以供比较，并且要注意让所有成员都能自在地参与讨论。1992年夏天，医疗保健筹资协会根据此处介绍的方法举办了一系列多专科小组会议，以制定1993年的RBRVS；此外，美国医学协会的RBRVS更新委员会在确定新的现行程序术语代码的相对工作价值时采用了小组流程和参考集。
