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PubMed1976

Time unit system of fee setting.

An efficient, accurate, and simple method was developed to determine charges for physical therapy services. Based on cost accounting, the charges were developed from the direct and indirect costs of operating the department. Methods to determine operating costs are outlined and the process used to establish a time unit system is presented. The charges to the patient were developed to reflect accurately the patient's use of resources in terms of time, supplies, and share of indirect costs. A differentiation was made between direct treatment time when the patient is in actual contact with a physical therapist or physical therapist assistant and nondirect time when the patient is practicing a skill on his own. Although developed for a medical center teaching hospital, this system can be adapted to any type of facility.

Cost-Benefit Analysis↗
PubMed2004

Impact of the introduction of fee for service payments on types of minor surgical procedures undertaken by general practitioners: observational study.

The 1990 general practitioners (GPs) contract introduced item of service payment for minor surgery, payable for six categories of procedure. Early review showed no substitution of cheaper procedures for more expensive treatments. Detailed payment data from six Health Authorities for the period 1993-2000 show an 11 per cent increase in claims, largely accounted for by the rise in cautery, incorporating cryotherapy. Cryotherapy is no more effective at treating warts than cheap commercially available products, but is quite profitable for GPs. This is yet another example of item of service payment distorting treatment priorities. The new GP contract, and the initiative to develop GPs with special interests in dermatology and minor surgery, will allow primary care trusts to develop minor surgery undertaken by appropriately skilled and experienced GPs, and which reflects the needs of the population.

Cautery↗