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Committee Representation and Medicare Reimbursements—An Examination of the Resource‐Based Relative Value Scale
Author(s) -
Gao Y. Nina
Publication year - 2018
Publication title -
health services research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.706
H-Index - 121
eISSN - 1475-6773
pISSN - 0017-9124
DOI - 10.1111/1475-6773.12857
Subject(s) - resource based relative value scale , scale (ratio) , value (mathematics) , resource (disambiguation) , medicare part b , actuarial science , business , medicine , computer science , statistics , mathematics , payment , finance , geography , computer network , cartography
Background The Resource‐Based Relative Value Scale Update Committee ( RUC ) submits recommended reimbursement values for physician work ( wRVU s) under Medicare Part B. The RUC includes rotating representatives from medical specialties. Objective To identify changes in physician reimbursements associated with RUC rotating seat representation. Data Sources Relative Value Scale Update Committee members 1994–2013; Medicare Part B Relative Value Scale 1994–2013; Physician/Supplier Procedure Summary Master File 2007; Part B National Summary Data File 2000–2011. Study Design I match service and procedure codes to specialties using 2007 Medicare billing data. Subsequently, I model wRVU s as a function of RUC rotating committee representation and level of code specialization. Principal Findings An annual RUC rotating seat membership is associated with a statistically significant 3–5 percent increase in Medicare expenditures for codes billed to that specialty. For codes that are performed by a small number of physicians, the association between reimbursement and rotating subspecialty representation is positive, 0.177 (SE = 0.024). For codes that are performed by a large number of physicians, the association is negative, −0.183 (SE = 0.026). Conclusions Rotating representation on the RUC is correlated with overall reimbursement rates. The resulting differential changes may exacerbate existing reimbursement discrepancies between generalist and specialist practitioners.