PHYSICIAN WORK EFFORT AND REIMBURSEMENT FOR RUPTURED ABDOMINAL AORTIC-ANEURYSMS

BACKGROUND: TWO major flaws have been previously identified in the res ource-based relative value scale (RBRVS): (1) inaccurate estimation of physician work effort; and (2) RBRVS compression, which results in un dervaluation of major surgical procedures. The impact of RBRVS for phy sicians treating patients with ruptured abdominal aortic aneurysms (RA AAs) has not been previously reported and is important owing to the se verity of the illness, the potential to quantitate actual work effort, and the high percentage of these patients covered by Medicare. PATIEN TS AND METHODS: Ali patients were studied who underwent surgery for RA AAs during a 5-year period encompassing the implementation of RBRVS. A nalysis included ail physician services including vascular surgeons, a nesthesiologists, and all other medical specialists. Total work effort was quantitated for each specialty in minutes/patient. The financial data were obtained by reviewing all professional bills and reimburseme nts. Cost of service was calculated to include physician compensation, practice overhead costs, and malpractice expenses. RESULTS: In all, 8 4 patients underwent repair of a RAAA with a mortality rate of 42%. Me dicare was the primary insurance for 87% of patients. The cost of serv ice exceeded the reimbursement by 50% for vascular surgeons, resulting in an average loss of $1,593/patient. Actual operative time represent ed only 24% of total surgical work effort. Early death and a length of stay (LOS) less than or equal to 1 day for 24 patients resulted in a reimbursement rate of $5.98/minute for surgeons. This gain was signifi cantly offset by 30 patients with a LOS greater than or equal to 14 da ys, resulting in a reimbursement rate of $1.94/ minute for vascular su rgeons. Over the B-year period there was a trend of decreasing reimbur sement for vascular surgeons (P <0.005) but not other physicians. Vasc ular surgeons incurred a 28% decrease in reimbursement over the study period. CONCLUSIONS: Physician reimbursement under RBRVS for the treat ment of patients with RAAAs is inadequate to cover the costs of provid ing this care. Reimbursement trends and potential changes to the pract ice component of the RBRVS will further aggravate the losses involved in caring for these very ill patients. Vascular surgeons must continue to provide input to the Health Care Financing Administration to help correct inequities built into RBRVS. (C) 1997 by Excerpta Medica, Inc.