An Overview of the Development and Refinement of the Resource-Based Relative Value Scale The Foundation for Reform of U.S. Physician Payment

Hsiao, William C.; Braun, Peter; Dunn, David A.; Becker, Edmund R.; Yntema, Douwe B.; Verrilli, Diana K.; Stamenovic, Eva; Chen, Shiao-ping

doi:10.1097/00005650-199211001-00001

Cited by 105 publications

(82 citation statements)

References 17 publications

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“…OC is a concept commonly used in commerce and economics to assign value to educational processes. The American Medical Association has used this method to assess the value of specialty education of physicians (Hsiao et al 1992). OC loss is the measure of forgone alternatives (Frank et al 2003).…”

Section: Discussionmentioning

confidence: 99%

The Current Certification Model: Does It Reflect Nursing Knowledge?

Joachim¹,

Saxe-Braithwaite²,

Mass³

et al. 2005

cjnl

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Although certification is widely believed to be important, little recognition is given to certified nurses. Many nurses choose not to certify or recertify based largely on the lack of recognition and the perception that the certification process is costly and lengthy. The aim of this project was to collect data, in a two-dimensional format, about the amount of time used to prepare for the Canadian Nurses Association (CNA) certification exams. On one axis, the specialties were noted, and on the other, the educational background was noted. A secondary aim of the project was to explore whether the concept of opportunity cost loss is useful for assessing the value of certification. Data from a group of certifying nurses were collected. Preparation time varied widely between individuals

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Section: Discussionmentioning

confidence: 99%

The Current Certification Model: Does It Reflect Nursing Knowledge?

Joachim¹,

Saxe-Braithwaite²,

Mass³

et al. 2005

cjnl

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“…14 In addition, the assignment of physician service costs using methods such Time-driven activity-based costing: a driver for provider engagement in costing activities and redesign initiatives as the ratio of costs to charges (RCC) or the Medicare resource-based relative value scale (RBRVS) has been criticized heavily regarding its allocation methodology and calibration. 3,11,19 Therefore, an updated, unified, reliable, and transparent method of measuring the costs of hospital-and physician-related services is needed. 33 Recently, time-driven activity-based costing (TDABC) has gained popularity in health economics as an accurate costing methodology that provides clinicians and staff with valid, actionable process and cost data to redesign care effectively.…”

Section: ©Aans 2014mentioning

confidence: 99%

Time-driven activity-based costing: a driver for provider engagement in costing activities and redesign initiatives

McLaughlin¹,

Burke

Setlur

et al. 2014

FOC

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Object. To date, health care providers have devoted significant efforts to improve performance regarding patient safety and quality of care. To address the lagging involvement of health care providers in the cost component of the value equation, UCLA Health piloted the implementation of time-driven activity-based costing (TDABC). Here, the authors describe the implementation experiment, share lessons learned across the care continuum, and report how TDABC has actively engaged health care providers in costing activities and care redesign.Methods. After the selection of pilots in neurosurgery and urology and the creation of the TDABC team, multidisciplinary process mapping sessions, capacity-cost calculations, and model integration were coordinated and offered to engage care providers at each phase.Results. Reviewing the maps for the entire episode of care, varying types of personnel involved in the delivery of care were noted: 63 for the neurosurgery pilot and 61 for the urology pilot. The average cost capacities for care coordinators, nurses, residents, and faculty were $0.70 (range $0.63-$0.75), $1.55 (range $1.28-$2.04), $0.58 (range $0.56-$0.62), and $3.54 (range $2.29-$4.52), across both pilots. After calculating the costs for material, equipment, and space, the TDABC model enabled the linking of a specific step of the care cycle (who performed the step and its duration) and its associated costs. Both pilots identified important opportunities to redesign care delivery in a costconscious fashion.Conclusions. The experimentation and implementation phases of the TDABC model have succeeded in engaging health care providers in process assessment and costing activities. The TDABC model proved to be a catalyzing agent for cost-conscious care redesign.

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“…Standardized costs are computed by applying the same price for each class of inputs across providers and over time, so that the observed variance in expenses is determined only by variations in mix and volumes of the various medical care services delivered to patients. A standardized costing scheme represents a set of relative resource intensity weights, akin to resource-based relative value units (RVUs) (16,17). Relative resource weights derive their face validity from knowing the types, intensity, and complexity of specific medical care services.…”

Section: Costing Basicsmentioning

confidence: 99%

A Standardized Relative Resource Cost Model for Medical Care: Application to Cancer Control Programs

et al. 2013

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Medicare data represent 75% of aged and permanently disabled Medicare beneficiaries enrolled in the fee-for-service (FFS) indemnity option, but the data omit 25% of beneficiaries enrolled in Medicare Advantage health maintenance organizations (HMOs). Little research has examined how longitudinal patterns of utilization differ between HMOs and FFS. The Burden of Cancer Study developed and implemented an algorithm to assign standardized relative costs to HMO and Medicare FFS data consistently across time and place. Medicare uses 15 payment systems to reimburse FFS providers for covered services. The standardized relative resource cost algorithm (SRRCA) adapts these various payment systems to utilization data. We describe the rationale for modifications to the Medicare payment systems and discuss the implications of these modifications. We applied the SRRCA to data from four HMO sites and the linked Surveillance, Epidemiology, and End Results-Medicare data. Some modifications to Medicare payment systems were required, because data elements needed to categorize utilization were missing from both data sources. For example, data were not available to create episodes for home health services received, so we assigned costs per visit based on visit type (nurse, therapist, and aide). For inpatient utilization, we modified Medicare's payment algorithm by changing it from a flat payment per diagnosis-related group to daily rates for diagnosis-related groups to differentiate shorter versus longer stays. The SRRCA can be used in multiple managed care plans and across multiple FFS delivery systems within the United States to create consistent relative cost data for economic analyses. Prior to international use of the SRRCA, data need to be standardized.

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An Overview of the Development and Refinement of the Resource-Based Relative Value Scale The Foundation for Reform of U.S. Physician Payment

Cited by 105 publications

References 17 publications

The Current Certification Model: Does It Reflect Nursing Knowledge?

The Current Certification Model: Does It Reflect Nursing Knowledge?

Time-driven activity-based costing: a driver for provider engagement in costing activities and redesign initiatives

A Standardized Relative Resource Cost Model for Medical Care: Application to Cancer Control Programs

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