2019 HSC Section 2 - Practice Management

QUALITY REPORT JACOBS ET AL VALUATION OF PHYSICIAN WORK

Ann Thorac Surg 2017;103:373 – 80

CMS has called for a higher degree of accuracy in the time domain than can be obtained by survey. The RUC has already established criteria for the use of objective sources of data about time to inform the valuation of CPT codes. Time can be measured (usually from data in an approved extant database such as the STS National Database) or estimated, but intensity can only be esti- mated by using one of several methods. The RUC has considered and used several methods to develop a reliable intensity valuation that is independent of time and work, essentially focusing the discussion on the average intensity of a given service. Several methods exist to estimate intensity, including the following techniques: 1. Rasch analysis 2. Intensity magnitude estimation (IME) by direct survey 3. Assignment by expert panels “ The Rasch model, named after Georg Rasch, is a psychometric model for analyzing categorical data, such as answers to questions on a reading assessment or questionnaire responses, as a function of the trade-off between (a) the respondent ’ s abilities, attitudes or per- sonality traits and (b) the item dif fi culty ” ( https://en. wikipedia.org/wiki/Rasch_model ). “ Rasch Analysis (RA) is a unique approach of mathe- matical modeling based upon a latent trait and accom- plishes stochastic (probabilistic) conjoint additivity (conjoint means measurement of persons and items on the same scale and additivity is the equal-interval prop- erty of the scale) ” ( http://www.rasch.org/rmt/rmt213d. htm ). Rasch analyses are frequently constructed as a se- ries of questions, with each question consisting of a comparison of two procedures, with the respondent determining which of the two procedures is more intense. A very large number of comparisons are required to create a valid survey. With IME by direct survey, the survey participant establishes relativity (rank order and degree of dispersion) of intensity between the code being surveyed and the intensities established for the codes in a reference intensity list. The survey results are presented for evaluation in exactly the same fashion as in the current magnitude estimation surveys for physician work (minimum, 25th percentile, median, 75th percentile, maximum). If the STS National Database provides data about time, a reliable method is necessary to estimate intensity. The STS Workforce on Coding and Reimbursement compared two proposed methods for estimation of in- tensity: Rasch analysis and IME by direct survey. Rasch is a psychometric model for analyzing categoric data using complex mathematical modeling. IME asks survey par- ticipants to estimate the average work intensity of a procedure and to compare this intensity to average work intensities of other established codes contained in a reference intensity list. The STS Workforce on Coding and Reimbursement compared 288 IME surveys to 747 Rasch surveys for 66 cardiothoracic surgical CPT codes. Figure 1 demonstrates a comparison of the estimated intensity derived from Rasch and IME. Statistical analysis

subspecialty, 1 for a primary care representative and 1 for any other specialty. Furthermore, there are seats for the RUC chair, the co-chair of the RUC Healthcare Pro- fessionals Advisory Committee Review Board, and rep- resentatives from the AMA, American Osteopathic Association, the Chair of the Practice Expense Review Committee and CPT Editorial Panel. The AMA Board of Trustees selects the RUC chair and the AMA representative to the RUC. Specialty societies nominate RUC individual members, who the AMA must also approve. Chair American Medical Association Representative CPT Editorial Panel Representative American Osteopathic Association Representative Health Care Professionals Advisory Committee Representative Practice Expense Review Committee Representative Anesthesiology Cardiology Colon and Rectal Surgery* Dermatology Emergency Medicine

Family Medicine General Surgery Geriatric Medicine Hematology* Internal Medicine Nephrology* Neurology Neurosurgery Obstetrics/Gynecology Ophthalmology Orthopaedic Surgery Otolaryngology

Pathology Pediatrics

Plastic Surgery Primary Care*

Psychiatry Radiology Thoracic Surgery Urology * Indicates rotating seat ”

An Example of Evolving Methodology in the Valuation of Physician Work With increased data available from multiinstitutional registries such as the STS National Database, the meth- odology of assigning value to physician work continues to evolve. The work RVU can be calculated by multiplying the time it takes to perform a service by the intensity of the service. In most instances, work RVUs are developed by magnitude estimation of work. This requires simulta- neous estimation of time and intensity, the product of which is work. Typically, surveys are performed to esti- mate work with this simultaneous estimation of time and intensity.

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