Vascular laboratory cost analysis and the impact of the Resource-Based Relative Value Scale payment system Mark F. Fillinger, MD, Robert M. Zwolak, MD,

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Presentation transcript:

Vascular laboratory cost analysis and the impact of the Resource-Based Relative Value Scale payment system Mark F. Fillinger, MD, Robert M. Zwolak, MD, PhD, Anne M. Musson, BS, RVT, Jack L. Cronenwett, MD Journal of Vascular Surgery Volume 17, Issue 2, Pages 267-279 (February 1993) DOI: 10.1016/0741-5214(93)90412-F Copyright © 1993 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 1 Change in global reimbursement for individual studies (percent change from previous system) versus frequency of each study in United States (expressed as a percentage of total studies). Each point (letter) represents one of new CPT codes. Most frequently performed studies have greatest decrease in reimbursement under new payment system. A, Carotid artery duplex; B, lower extremity arterial examination; C, venous doppler, IPG, or PPG (one code under new system); D, OPG; E, lower extremity duplex; F, venous duplex; G, upper extremity arterial study; H, visceral vascular duplex; I, upper extremity duplex. Journal of Vascular Surgery 1993 17, 267-279DOI: (10.1016/0741-5214(93)90412-F) Copyright © 1993 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 2 Comparison of national average technical and professional reimbursement per study under previous payment system and under RBRVS guidelines. Technical reimbursement decreased by 27%, whereas professional reimbursement decreased by 52%. Journal of Vascular Surgery 1993 17, 267-279DOI: (10.1016/0741-5214(93)90412-F) Copyright © 1993 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 3 Global reimbursement under previous payment system and RBRVS-based Medicare Part B payment system in terms of dollars per hour for eight most commonly performed studies in United States. Because previous system had only one code for peripheral duplex scanning, data for all peripheral duplex codes in new system are averaged as means of comparison. Studies are shown in decreasing order of frequency from left to right. LE, Lower extremity; UE, upper extremity. Journal of Vascular Surgery 1993 17, 267-279DOI: (10.1016/0741-5214(93)90412-F) Copyright © 1993 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 4 Comparison of technical costs for three vascular laboratory models and reimbursement under new RBRVS Medicare payment system. Neither technical reimbursement nor global (technical plus professional) reimbursement meets technical costs under RBRVS system. Journal of Vascular Surgery 1993 17, 267-279DOI: (10.1016/0741-5214(93)90412-F) Copyright © 1993 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 5 Cost/efficiency curves for two different size laboratory models comparing technical costs with technical component reimbursement under new RBRVS payment system. One-unit laboratory model has one technologist and one examination room, whereas four-unit model is based on four technologists and four examination rooms. Our estimate of average efficiency is 77%. Journal of Vascular Surgery 1993 17, 267-279DOI: (10.1016/0741-5214(93)90412-F) Copyright © 1993 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions