title: Missing productivity gains in the Medicare physician Fee Schedule: where are they?
abstract: The Medicare Fee Schedule with payments for thousands of visits and procedures is updated periodically for the work component of changes in physician relative work. Three 5-year reviews of physician work by Medicare have been biased against finding productivity gains and reductions in physician work relative values. The authors present four studies showing shorter physician times with patients in their offices and in the operating room, increases in surgeons' self-reported total work in spite of declining operating room times, and growing numbers of costly handoffs to nonsurgeons, while surgeons receive full payment for postoperative follow-up with patients. Substantial savings exist in the fee schedule if productivity gains from greater delegation to ancillary staff and specialists, reengineering of services, and rapid learning by experience with new technologies were integrated into the periodic reviews.
authors.affiliation: Research Triangle Institute, Research Triangle Park, NC, USA. jcromwell@rti.org
authors.forename: Jerry
authors.initials: J
authors.lastname: Cromwell
authors.forename: Nancy
authors.initials: N
authors.lastname: McCall
authors.forename: Kathleen
authors.initials: K
authors.lastname: Dalton
authors.forename: Peter
authors.initials: P
authors.lastname: Braun
mesh_terms: D004526:Efficiency; D005245:Fee Schedules; D006801:Humans; D006278:Medicare / Q000191:economics*; D009819:Office Visits / Q000191:economics / Q000706:statistics & numerical data; D009873:Operating Rooms / Q000191:economics / Q000706:statistics & numerical data; D010820:Physicians / Q000191:economics*; D015895:Relative Value Scales; D013997:Time Factors; D014481:United States; D016526:Workload / Q000706:statistics & numerical data