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.