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Biomedical subjects

E R Becker

Publications and source records attributed to E R Becker.

At least 55 records · Page 3Linked to original sources
PubMed1990

An analysis of hospital union election activity: 1985-1987--by hospital ownership, size, and system, and employee organization and bargaining-unit size.

During the three-year period 1985-1987, there were 238 elections in nongovernmental, short-term hospitals to determine whether or not unions would represent the employees. Unions had a success rate of 47.1 percent, similar to that of earlier years. This study reports these election results by hospital and election characteristics. For hospitals, the analysis includes elections by census region, ownership, bed size, and multi-institutional characteristics. For elections, the analysis includes the nature and type of election, employee organization, and employee bargaining-unit-size characteristics. This study concludes that the number of union elections decline as hospital bed size increases, and the union success rate is curvilinear and higher in both small and very large hospitals; union success declines as bargaining-unit size increases. Investor-owned and nonprofit, religious hospitals that are members of multi-institutional systems have lower union success rates than nonsystem hospitals do in their ownership category. However, unions are much more successful in multi-union and decertification elections compared with single-unit elections and initial recognition elections.

Data Collection↗
PubMed1990

Refinement and expansion of the Harvard Resource-Based Relative Value Scale: the second phase.

The Harvard resource-based relative value scale (RBRVS) for physician services has assumed a critical role in physician payment reform. We have demonstrated that the relative resource costs of providing physician services can be defined and measured in a rational and systematic way and that the results are reliable and valid. Consequently, the RBRVS is a viable basis for national payment policy and could be used for establishing a national fee schedule for physician services or to identify "mispriced" physician procedures. Since the release of the final report of the first phase of the Harvard RBRVS study in September of 1988, there has been extensive review, discussion, and criticism of the RBRVS. Dr. Laurence F. McMahon, Jr., in the accompanying article, provides a further critique of our research. In this paper, we review the RBRVS study and results and respond to the major criticisms that have been raised by Dr. McMahon and others. We then describe the tasks we are currently undertaking to expand and validate our research and address the important criticisms and limitations.

Data Interpretation, Statistical↗
PubMed1988

Resource-based relative values. An overview.

Studies have been conducted over the past decade to develop a Resource-Based Relative Value Scale (RBRVS) for physicians' services. Policymakers view an RBRVS as a potential tool to pay physicians. The Physician Payment Review Commission, under a congressional mandate, has endorsed the general concept of a fee schedule based on resource costs for physician payment under Medicare. In this overview article, we present the policy context in which the RBRVS may play a role and describe the approach taken to develop this scale, specifically consultation with clinicians, researchers, and insurers and data gathering, including a national survey of physicians. We discuss underlying elements that are necessary to constructing an RBRVS, each of which is described more fully in subsequent articles: measuring the work (intraservice work) of performing medical services and procedures, estimating preservice and postservice work, comparing work across specialties, measuring practice costs, extrapolating from surveyed services, and establishing an RBRVS for evaluation/management services and for invasive procedures. Overall results are presented in a companion article.

Costs and Cost Analysis↗
PubMed1988

Results, potential effects, and implementation issues of the Resource-Based Relative Value Scale.

This article presents the overall results of the Resource-Based Relative Value Scale (RBRVS) study. We present resource-based relative values for selected services in each of the 18 specialties we studied. We found that preservice and postservice work represents close to 50% of total work for invasive services and 33% of total work for evaluation/management services. We also found that the work per unit time (a measure of intensity) for invasive services is about three times that of evaluation/management. We developed a simple model and simulated an RBRVS-based fee schedule for the Medicare program under a "budget-neutral" assumption. Results for 30 commonly performed services show that office visit fees for evaluation/management services could rise by 70%, while some surgical fees could drop by 60%. We also simulated what the Medicare outlays would have been in 1986 for categories of medical services under an RBRVS-based fee schedule. We found that total Medicare payments for evaluation/management services would have increased by about 56%. Invasive, imaging, and laboratory services would have decreased by 42%, 30%, and 5%, respectively. We also discuss implementation issues related to an RBRVS-based fee schedule, such as the determination of a monetary conversion factor, practice costs, billing codes, and the need to evaluate the potential impacts of an RBRVS-based payment system on the cost and quality of health care.

Costs and Cost Analysis↗
PubMed1988

Relative cost differences among physicians' specialty practices.

Practice costs, defined as those costs of medical practice that exclude the physician's own time and effort, represent a substantial portion of the resources necessary to perform a service. In this article we describe the development of the practice cost index used in constructing the Resource-Based Relative Value Scale (RBRVS). We derived the practice cost index value for each specialty, using specialty-specific practice costs and gross revenue data. The index values for all other specialties are standardized to the value for general surgery, and these are used to adjust the resource-based relative values for services performed by each specialty; in this way, the RBRVS incorporates practice cost variations. The data used in the construction of the practice cost index are the 1983 Physician Practice Cost and Income Survey data, adjusted to reflect the relative levels of 1986 professional liability insurance. Our findings show that among most specialties, the range of relative difference in practice costs as a percentage of gross revenue is approximately 15%. Four specialties fall outside this range: pathology, psychiatry, rheumatology, and orthopedic surgery. We discuss problems with the available data on practice costs as these relate to their use in the RBRVS and conceptual issues in applying practice costs to the construction of the RBRVS.

Costs and Cost Analysis↗
PubMed1988

Evaluation and management services in the Resource-Based Relative Value Scale.

Evaluation and management (E/M) services, which include making diagnoses, counseling and educating, developing strategies of care, and following up on treatment, are common to all medical specialties. Surveys of a variety of specialists using the magnitude-estimation method show that physicians agree closely in rating the work of particular E/M services. Regardless of the type of E/M service, the site at which it is performed, or the specialty performing it, work per unit of time varies only slightly. Comparison of work and time for services to which experts assigned billing codes in our consultative process indicates, however, that there may be large differences in the way different specialties use these billing codes. In some instances, work entailed by some of the E/M billing codes within specialties also appears to vary substantially. If empirical studies of physicians' coding and billing practices support our findings, possible responses might include (1) developing specialty-specific resource-based relative values for E/M services and (2) redefining the Physicians' Current Procedural Terminology, edition 4, codes for these services in terms that include time specifications.

Economics, Medical↗
PubMed1988

Resource-based relative values for invasive procedures performed by eight surgical specialties.

We surveyed approximately 850 physicians in eight surgical specialties to investigate physicians' work in performing invasive services. Building on our analysis of physician work, we developed a relative value scale of physicians' services based on resource costs. First, we found that physician charges are not set in proportion to the resources required to perform a given procedure: there is a threefold variation, across hospital-based invasive procedures, in the ratio of charges to resource-based relative values. Second, for most procedures, the preoperative and postoperative periods represent 60% to 75% of a physician's total service time, but only 35% to 50% of the total service work. Lastly, intraoperative work per unit of time varies greatly. Work per minute for invasive procedures is two to three times that of medical office visits and is strikingly greater for some specialties. The Resource-Based Relative Value Scale, at a minimum, represents a useful tool for payers to identify procedures with potentially aberrant charges and also offers unique insights into the nature of physicians' work.

Ambulatory Surgical Procedures↗
PubMed1988

Estimating physicians' work for a resource-based relative-value scale.

We have developed a resource-based relative-value scale as an alternative to the system of payment based on charges for physicians' services. Resource inputs by physicians include (1) total work input performed by the physician for each service; (2) practice costs, including malpractice premiums; and (3) the cost of specialty training. These factors were combined to produce a relative-value scale denominated in nonmonetary units. We describe here the process by which the physician's work was defined and estimated. The study asked two questions: What is the physician's work for each service performed? and Can work be estimated reliably and validly? We concluded that a physician's work has four major dimensions: time, mental effort and judgment, technical skill and physical effort, and psychological stress. We found that physicians can rate the relative amount of work of the services within their specialty directly, taking into account all the dimensions of work. Moreover, these ratings are highly reproducible, consistent, and therefore probably valid.

Economics, Medical↗
PubMed1988

Results and policy implications of the resource-based relative-value study.

The resource-based relative-value scale (RBRVS) is a measure of relative levels of resource input expended when physicians produce services and procedures. It is a function of the physician's work input, the opportunity cost of specialty training, and the relative practice costs for each specialty. This paper presents resource-based relative values (RBRVs) for selected procedures of four major specialties--family practice, internal medicine, general surgery, and thoracic and cardiovascular surgery. We compare RBRVs with current charges and find several general patterns. Invasive procedures are typically compensated at more than double the rate of evaluation-and-management services, when both consume the same resource inputs. Imaging and laboratory procedures fall between invasive and evaluation-and-management services. We analyze the financial implications of the RBRVS by developing a simple model and simulating the effects of an RBRVS-based fee schedule on physicians' revenues in various specialties. We use Medicare data to perform the simulation under the "budget-neutral" assumption. Results show that an RBRVS-based fee schedule affects specialties differently. The average family practitioner could receive 60 percent more revenue from Medicare, whereas the average ophthalmologist could lose 40 percent of current revenues. The effects on other specialties fall between these two.

Economics, Medical↗
PubMed1988

Hospital union election activity, 1974-85.

This study, using National Labor Relations Board data and American Hospital Association data, reports on the status of union election activity in the hospital industry for a 65-month period, January 1980-May 1985, and contrasts it with earlier data for a similar 65-month time period (1974-79). Together these data provide a comprehensive overview of union election activity in non-Federal, nongovernment hospitals since the passage of the 1974 Nonprofit Hospital Amendments to the Taft-Hartley Act. The study analyzes union, election, hospital, and environmental characteristics. Comparisons over the two time periods show that, while union victory rates in hospital elections have remained constant, the total number of elections has declined dramatically in the hospital industry.

Data Collection↗
PubMed1987

The Resource-Based Relative Value Scale. Toward the development of an alternative physician payment system.

This article describes the design and methods of a study currently under way to develop a Resource-Based Relative Value Scale (RBRVS); an alternative basis for establishing the payment rate for the services and procedures (S/Ps) of physicians in medical and surgical specialties. Physician resource inputs to be measured include (1) S/P time, (2) pre-S/P and post-S/P times, (3) intensity, (4) practice costs, including malpractice premiums, and (5) the cost of specialty training. These five factors will be combined to produce an RBRVS denominated in nonmonetary units. In the initial phase of the study, data on time and intensity will be obtained through a national survey of physicians who perform these S/Ps. In the second, consensus phase of the project, the investigators will convene a panel of representatives of the medical profession, third-party payers, consumers, and other interested parties to examine areas of agreement and disagreement as to how an RBRVS should be used for policy purposes. The final results of this study are expected by the summer of 1988.

Costs and Cost Analysis↗
PubMed1985

Impact of board certification on physician practice characteristics.

In the study reported here, the authors, using data from two American Medical Association surveys, examine the impact of board certification on selected physician practice characteristics. The results indicate that board certification is more prevalent for certain specialties, ages, types of practice, and locations of practice. Board certification has a substantial impact on the gross income of most major specialties, but these differences decline significantly for net incomes. Finally, comparisons of the hours worked per week and weeks worked per year show only small differences between board-certified and nonboard-certified physicians.

Adult↗
PubMed1985

Hospital ownership and performance.

This study compares the performance of three ownership forms of hospitals: for profit, private nonprofit, and public, further classified according to whether or not the hospital is run by a hospital chain. Data come from a 1979 national survey of U.S. hospitals. The authors find that hospital cost is quite similar among alternative ownership forms as is profitability. The results do not provide much empirical support for standard property rights theory. Several reasons are suggested why this may be so.

Costs and Cost Analysis↗
PubMed1984

Physician practice patterns under hospital rate-setting programs.

Earlier studies of hospital rate-setting programs have focused primarily on their ability to contain the growth in hospital utilization and expenditures. While most analysts recognize the central role physicians play in influencing health care utilization and expenditures, regulatory programs have been directed primarily at the hospital. At this time, it is unclear what impact, if any, these programs have had on physicians. Our study presents a preliminary analysis of this issue based on data from 1978 to 1982. When we compared average incomes, fees, and utilization of physician services in states with hospital rate regulations with those in states without such programs, we found significant differences. Average net incomes grew at a 1.9% slower annual rate in states with strict hospital regulatory programs. If hospital regulation is having some impact on physicians, both the physician and hospital sector should be considered when evaluating the ability of these programs to contain health care costs.

Economics, Hospital↗
PubMed1984

Cross-subsidies and payment for hospital care.

This study uses hospital data from the 1979 American Hospital Association Reimbursement Survey in a multivariate framework to assess the impact of discounts and third-party reimbursement on hospital costs and profitability. Three central issues are addressed: (1) Is a differential payment justified for Medicare, Medicaid, and/or Blue Cross on the basis of differential costs? (2) Have the cost-containment efforts of the dominant payers reduced total payments to hospitals? and (3) What part of the overall savings in payments to hospitals is in the form of reduced costs rather than reduced profits? On the basis of the evidence in this study, we find (1) that the differential payment is not justified; (2) that the cost-containment efforts of the dominant payers have reduced total payments to hospitals somewhat, but a substantial amount of cost-shifting remains; and (3) that the savings is in profits, rather than in costs.

Blue Cross Blue Shield Insurance Plans↗