Alternative Methods for Describing Physician Services Performed and Billed

摘要

To date, Federal efforts to control physician expenditure inflation have focused primarily on either restraining fee increases or reducing unnecessary utilization. Effective cost control, however, can only be achieved by controlling price and quantity simultaneously, and this requires an innovative approach to reimbursing physicians. This report explored new ways of 'packaging' physician services, approaches that redefine the payment unit from a narrow procedure to a more comprehensive bundle of services. Using 1981 Medicare Part B claims from Michigan and South Carolina, the authors simulated what these packages might look like. The absence of good casemix measures would appear to render ambulatory care packages infeasible, at least at the present time. Two other types of packages definitely seem feasible and appropriate for further study by HCFA, however: the special procedure package and the inpatient condition package (also known as physician DRGs). A special procedure consists of all related components of a diagnostic or therapeutic procedure. An inpatient condition package is even broader in scope, encompassing all physician services provided during the hospital stay.