High-Cost Medical Staffs: A Policy Option for Controlling the Volume of Physician Services in the Hospital.

摘要

This considers the high-cost medical staff as an alternative to the national Medicare Volume Performance Standards (MVPS). The alternative includes all physicians practicing in a hospital as a separate MVPS pool. Efforts to control hospital facility costs serve as precedents for three medical staff strategies. The preferred strategy would involve only a minority of medical staff--those whose practice patterns are clearly outside the norm; and is an incremental approach. A medical staff could be designated as 'high-cost' if its Relative Value Units (RVUs) per admission in a base year were greater than some multiple of the national average RVUs. The option is designed using a percentage withhold which would be (1) returned in full with interest, (2) returned in part, or (3) not returned at all depending upon medical staff performance. As designed it does not affect beneficiary liability. Technical analyses in support of various design options suggest that RVUs per admission should be adjusted for casemix and hospital level characteristics such as teaching status. In addition, an outlier threshold could be incorporated. Medical staffs have enough structure to implement a cost-containment policy and direct incentives as compared to incentives derived from the national risk pool.