Analyzing the role of physicians in determining health care payment policies

The Foundation's Investigator Awards in Health Policy Research Program was designed to produce major works from senior and new investigators that would add to the health policy field's knowledge base.The project, The Politics of Relative Values: Physicians and Medicare Fees, explores why Medicare payment reforms, which included the introduction of the Resource-Based Relative Value Scale (RBRVS), in the early 1990s, fell short of original objectives to contain Medicare cost growth and reduce reimbursement differences between primary care physicians and procedure-oriented specialists. The grantee will explore the role of physicians' participation in the scheduled reviews of the RBRVS, a process that has been largely undocumented and unobserved by researchers. The research will focus on the impact of the periodic adjustment process on RBRVS payments, how the review process may have contributed to escalating expenditures, and whether increasing primary care representation on the Relative Value Update Committee would lead to higher primary care payments. Findings will address the strengths and limitations of the process used to determine Medicare physician fee levels as well as the future role of physicians in determining payment policies. Deliverables include journal articles, presentations at professional meetings, and a book manuscript.