Witsberger C.

AHSR FHSR Annu Meet Abstr Book. 1994; 11: 122.

Lewin-VHI, Inc., Fairfax, VA 22031.

PROBLEM AND OBJECTIVES. This paper presents findings from a study performed for the CHAMPUS (Civilian Health and Medical Program of the Uniformed Services) insurance program to inform their physician payment policy, which is in transition from a prevailing charge system to use of the Medicare physician fee schedule. The study analyzes the relationship between patient age and physician "costs," to assess the appropriateness of using the same payment rates for adult and pediatric surgical services. DATA AND METHODS. The analysis used national CHAMPUS claims from July 1991 through June 1992--201,361 claims for 67 surgical procedures comprised the analytic sample. Ordinary least-squares regression models estimate the relationship of patient age to physician "costs", proxied by billed charges, with individual claims as the unit of analysis. After adjusting charges for geographic variations, the dependent variable was constructed as the ratio of a claim's charge to the adult average charge for the same procedure. Explanatory variables were dummies indicating patient age group (0-2, 3-5, 6-17, and 18+ as the omitted category). Separate models were run for each body system. Correlation statistics between physician charges and Medicare RVUs measure the association between charges and actual physician cost. Finally, physician specialty distribution and dependent variable means for each procedural and age category are presented to assess specialty effects. RESULTS AND CONCLUSIONS: The regressions estimate: 1)significantly higher costs for children for procedures in the cardiovascular, digestive, ocular and auditory body systems; 2) significantly lower pediatric costs for integumentary, musculoskeletal and nervous system procedures; and 3) no significant difference in adult and pediatric costs for respiratory and urinary/genital procedures. The correlation between charges and RVUs for adults was .86, supporing the validity of the findings. The specialty-and age-specific average charges and casemix do not support the conclusion that results are due to specialty pricing differentials. IMPLICATIONS FOR AUDIENCE: Implications of the research results for physician payment reform and the impact on physician's revenues are discussed.

Publication Types:

• Meeting Abstracts

Keywords:

• Adult
• Capitation Fee
• Child
• Fee Schedules
• Fee-for-Service Plans
• Fees and Charges
• Fees, Medical
• Humans
• Medicare
• Physicians
• Specialties, Medical
• economics
• methods
• surgery
• hsrmtgs

Other ID:

• HTX/94911015

UI: 102212162

From Meeting Abstracts