United States Government Publishing Office publisher pbl distributor dst United States Government Accountability Office Health, Education, and Human Services Division author aut Government Organization text government publication eng GAOREPORTS Legislative Agency Publications gao legislative 2010-08-12 U.S. Government Printing Office 1999-02-24 monographic deposited born digital 59 p. GA 1.13:HEHS-99-30 https://www.govinfo.gov/app/details/GAOREPORTS-HEHS-99-30 P0b002ee180394220 f:he99030 DGPO 2010-08-12 2011-03-28 GAOREPORTS-HEHS-99-30 machine generated eng fdlp REPORT GAOREPORTS-HEHS-99-30 HEHS-99-30 Medical fees Health care programs Medical services rates Health care costs Medical economic analysis Data integrity Physicians Overhead costs Statistical methods Medicare Program Letter Report HEHS Pursuant to a congressional request, GAO reviewed the Health Care Financing Administration's (HCFA) ongoing efforts to develop resource-based practice expense relative value units (RVUs), focusing on: (1) whether the new methodology is an acceptable approach for revising Medicare's fee schedule; (2) questions about the data, assumptions, and adjustments underlying the new methodology that need to be addressed during the 3-year phase-in period; and (3) the need for future updates to the practice expense RVUs to reflect changes in health care delivery and for ongoing assessments of the fee schedule's effect on Medicare beneficiaries' access to physicians' care.<p/>GAO noted that: (1) HCFA's new methodology represents an acceptable approach for calculating RVUs; (2) HCFA relied on the best data available for creating the new values: (a) a nationally representative survey of physicians' practice costs; and (b) data developed by panels of experts that identify the specific resources associated with individual procedures; (3) HCFA's original and new proposals use these data in similar ways to create the new RVUs; (4) a critical difference is that the new methodology more directly recognizes the variation in practice expenses among physicians' specialities in computing the RVUs; (5) additionally, this methodology responds to several concerns GAO had with the original one; (6) while HCFA's new methodology is acceptable overall, certain questions about the data and underlying methodology need to be addressed before the new RVUs are completely phased in; (7) for example, the national practice expense survey database contains limited data for some specialties and may lead to imprecise estimates of their practice expenses; (8) for other specialities not included in the survey database, HCFA had to use proxy information, the appropriateness of which needs to be verified; (9) also, HCFA made certain assumptions and adjustments without confirming their reasonableness; (10) for example, HCFA adjusted the supply cost estimates for oncologists to avoid paying them twice for chemotherapy drugs but HCFA has not yet collected data to determine the appropriate size of the adjustment; (11) to address these issues, HCFA needs a strategy for refining the practice expense RVUs during the 3-year phase-in period that focuses on the data and methodology weaknesses that have the greatest effect on the RVUs; (12) however, HCFA has done little in the way of sensitivity analysis to effectively target its refinement efforts; (13) additionally, HCFA has not developed permanent processes for future updates and revisions to the practice expense RVUs as new procedures are developed or methods of performing existing procedures shift; and (14) finally, HCFA needs to continue monitoring beneficiaries' access to physicians' care to ensure that access is not compromised by past and ongoing changes to Medicare's payments to physicians. https://www.govinfo.gov/content/pkg/GAOREPORTS-HEHS-99-30/html/GAOREPORTS-HEHS-99-30.htm https://www.govinfo.gov/content/pkg/GAOREPORTS-HEHS-99-30/pdf/GAOREPORTS-HEHS-99-30.pdf GAO/HEHS-99-30 https://www.govinfo.gov/app/details/GAOREPORTS-HEHS-99-30 Letter Report GAO/HEHS-99-30; Medicare Physician Payments: Need To Refine Practice Expense Values During Transition and Long Term; Medical fees Health care programs Medical services rates Health care costs Medical economic analysis Data integrity Physicians Overhead costs Statistical methods Medicare Program Volume 100 Page 82 100 Stat. 82 Volume 103 Page 2106 103 Stat. 2106 Volume 108 Page 4398 108 Stat. 4398 Volume 111 Page 251 111 Stat. 251 Public Law 99-272 Public Law 101-239 Public Law 103-432 Public Law 105-33