Comparison of nurse practitioner and family physician relative work values

Purpose: With the enactment of the Balanced Budget Act of 1997, American nu rse practitioners were granted direct Medicare reimbursement for Part B ser vices. Payment structures in fee-for-service and managed care systems are p hysician-based, leading to difficulties in constructing payments for other health care professionals. The purpose of this Pilot study was to examine t he feasibility of using nurse practitioner data for specifying relative wor k values in the Medicare Fee Schedule for three office-visit codes. Design: An exploratory survey was designed to establish relative work value s using magnitude-estimation scaling. Nurse practitioners (N=43) responded to a structured questionnaire in a national mail survey. Physician data (N= 46) were obtained from a computerized database from the American Academy of Family Physicians. Methods: The methods used in this study were the same as the process used b y the American Medical Association and the Health Care Financing Administra tion to establish relative work values in the Medicare I;ee Schedule. Respo ndents established relative work values for three Current Procedural Termin ology (CPT) codes for office visits (99203, 99213, 99215) commonly billed i n primary care practice. Each CPT code descriptor and associated vignette w ere compared with reference services germane to the practice of nurse pract itioners and family physicians, using magnitude-estimation scaling. To esta blish relative work values for each code, respondents were asked to conside r the time to provide the service and intensity of the work involved for ea ch CPT code. Findings: No significant differences between nurse practitioners and family physicians were found in the three CPT codes for relative work values and intensity. Nurse practitioners estimated significantly (P < .01) higher int raservice (face to face) time with patients than did family physicians, and family physicians estimated significantly (P < .05) higher pre-service tim e for two codes and significantly (p < .05) higher postservice times for th ree codes. Conclusions: Nurse practitioner relative work values did not differ signifi cantly from family physician relative work values, Although the sample size s were small, the significance of the findings support the need for further research with large data sets and additional CPT codes. Such studies could then be used as a basis for decisions about Medicare payment and public po licy.