Using a New Type-of-Service Classification System to Examine the Growth inMedicare Physician Expenditures, 1985-1988

摘要

The paper describes the development of a new Medicare physician type of service(TOS) classification system which subdivides Medicare categories of services into less aggregate groupings than the current system. Although the primary objective of the study was to allow better discrimination between services, the new taxonomy is also comprehensive, allows mutually exclusive assignment of codes, is clinically meaningful, objective, and stable over time, and minimizes the use of residual categories. Using the new TOS system, physicians classified over 7,000 Health Care Financing Administration (HCFA) Common Procedure Coding System (HCPCS) service codes into 21 types of services. These consist of six evaluation and management (E/M) services categories, three procedures categories, imaging, tests, anesthesiology, and others. The paper examines the growth in allowed charges for Medicare physician services between 1985 and 1988 using the new TOS system. Over this time period there was a rapid rate of growth for emergency room services and specialty specific E/M services, advanced imaging and sonography, and the use of tests, both laboratory and other. Most major surgical procedures did not experience much of an increase except for cardiovascular surgery and ambulatory eye procedures. The final section of the paper describes growth in allowed charges and allowed services for high volume procedures.