程序的合理成本：对医疗保健提供者的匿名调查。

IF 2.3 Q2 ECONOMICS

Journal of Health Economics and Outcomes Research Pub Date : 2025-09-08 eCollection Date: 2025-01-01 DOI:10.36469/001c.143489

David Shin, Carson Cummings, David Cheng, Chandler Dinh, Daniel Im, Timothy Tang, Isabella Oh, Lauren Han, Patricia Carlson, Gideon Harianja, Jacob Razzouk, Olumide Danisa, Wayne Cheng

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Cost discrepancies can discourage physician participation in Medicare and Medi-Cal, potentially limit access to care for vulnerable patient populations, and complicate the determination of proper compensation in court.Objectives: To survey healthcare providers to determine reasonable costs for medical procedures, potentially aligning legal standards with healthcare costs.Methods: An anonymous, 8-question electronic survey was distributed through Survey Legend® between February and September 2023 to providers in orthopedic surgery, neurosurgery, anesthesiology, interventional radiology (IR), physical medicine and rehabilitation (PMR), pain management, and physician assistants (PAs) or nurse practitioners (NPs). Three procedures-epidural injection, facet injection/medial branch block, and radiofrequency ablation-were included, with participants selecting from 5 cost categories: < <math><mn>1000</mn> <mo>,</mo></math> 1000- <math><mn>4999</mn> <mo>,</mo></math> 5000- <math><mn>9999</mn> <mo>,</mo></math> 10000- <math><mn>19999</mn> <mo>,</mo> <mi>a</mi> <mi>n</mi> <mi>d</mi> <mo>></mo></math> 20,000. Additional questions explored participant insight into discounts for cash and lien-based payments.Results: For all procedures and participants, the most common value was <math><mn>1000</mn> <mo>-</mo></math> 4999. Neurosurgery selected significantly higher epidural values than pain management (P=.025), PMR (P=.029), and PA/NP (P=.04); higher facet injection/medial branch block values than PMR (P=.03) and PA/NPs (P=.01); and higher radiofrequency ablation values than PA/NPs (P=.02). Physicians not accepting lien payments showed significantly lower values across all specialties and procedures.Discussion: The range of reported reasonable costs by respondents reflects a discrepancy between physician expectations and existing reimbursement models, indicating a lack of a standardized value for procedural pricing. Medicare's estimated <math><mn>500</mn> <mi>r</mi> <mi>e</mi> <mi>i</mi> <mi>m</mi> <mi>b</mi> <mi>u</mi> <mi>r</mi> <mi>s</mi> <mi>e</mi> <mi>m</mi> <mi>e</mi> <mi>n</mi> <mi>t</mi> <mi>f</mi> <mi>o</mi> <mi>r</mi> <mi>e</mi> <mi>p</mi> <mi>i</mi> <mi>d</mi> <mi>u</mi> <mi>r</mi> <mi>a</mi> <mi>l</mi> <mi>i</mi> <mi>n</mi> <mi>j</mi> <mi>e</mi> <mi>c</mi> <mi>t</mi> <mi>i</mi> <mi>o</mi> <mi>n</mi> <mi>s</mi> <mi>a</mi> <mi>n</mi> <mi>d</mi> <mi>f</mi> <mi>a</mi> <mi>c</mi> <mi>e</mi> <mi>t</mi> <mi>i</mi> <mi>n</mi> <mi>j</mi> <mi>e</mi> <mi>c</mi> <mi>t</mi> <mi>i</mi> <mi>o</mi> <mi>n</mi> <mrow><mo>/</mo></mrow> <mi>m</mi> <mi>e</mi> <mi>d</mi> <mi>i</mi> <mi>a</mi> <mi>l</mi> <mi>b</mi> <mi>r</mi> <mi>a</mi> <mi>n</mi> <mi>c</mi> <mi>h</mi> <mi>b</mi> <mi>l</mi> <mi>o</mi> <mi>c</mi> <mi>k</mi> <mi>s</mi> <mi>a</mi> <mi>n</mi> <mi>d</mi></math> 1000 for radiofrequency ablation are below both physician-perceived reasonable costs and the inflated charges often found in lien-based cases. In contrast, personal injury billing can reach as high as $20,000 for an epidural injection, a cost category that only 2.9% of survey respondents chose.Conclusion: This survey highlights healthcare providers' perceptions of reasonable costs for procedures, possibly assisting in refining reimbursement models, ensuring consistency in legal proceedings, and maintaining proper accessibility and compensation for patients and providers.","PeriodicalId":16012,"journal":{"name":"Journal of Health Economics and Outcomes Research","volume":"12 2","pages":"108-115"},"PeriodicalIF":2.3000,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12422406/pdf/","citationCount":"0","resultStr":"{\"title\":\"Reasonable Cost for Procedures: An Anonymous Survey of Healthcare Providers.\",\"authors\":\"David Shin, Carson Cummings, David Cheng, Chandler Dinh, Daniel Im, Timothy Tang, Isabella Oh, Lauren Han, Patricia Carlson, Gideon Harianja, Jacob Razzouk, Olumide Danisa, Wayne Cheng\",\"doi\":\"10.36469/001c.143489\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"Background: The cost of medical procedures in the United States varies dramatically depending on the payment system, including Medicare, Medi-Cal (California's Medicaid program), private insurance, or lien-based payment models used in personal injury cases. Cost discrepancies can discourage physician participation in Medicare and Medi-Cal, potentially limit access to care for vulnerable patient populations, and complicate the determination of proper compensation in court.Objectives: To survey healthcare providers to determine reasonable costs for medical procedures, potentially aligning legal standards with healthcare costs.Methods: An anonymous, 8-question electronic survey was distributed through Survey Legend® between February and September 2023 to providers in orthopedic surgery, neurosurgery, anesthesiology, interventional radiology (IR), physical medicine and rehabilitation (PMR), pain management, and physician assistants (PAs) or nurse practitioners (NPs). 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Physicians not accepting lien payments showed significantly lower values across all specialties and procedures.Discussion: The range of reported reasonable costs by respondents reflects a discrepancy between physician expectations and existing reimbursement models, indicating a lack of a standardized value for procedural pricing. 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引用次数: 0

摘要

背景：美国医疗程序的费用因支付系统的不同而有很大差异，包括医疗保险、Medi-Cal（加州医疗补助计划）、私人保险或人身伤害案件中使用的基于留置权的支付模式。费用差异会阻碍医生参与医疗保险和Medi-Cal，可能会限制弱势患者群体获得医疗服务，并使法庭上适当赔偿的确定复杂化。目的：调查医疗保健提供者，以确定医疗程序的合理成本，可能使法律标准与医疗保健成本保持一致。方法：在2023年2月至9月期间，通过survey Legend®对骨科、神经外科、麻醉学、介入放射学（IR）、物理医学与康复学（PMR）、疼痛管理、医师助理（PAs）或执业护士（NPs）的提供者进行了一项8题的匿名电子调查。包括三种手术-硬膜外注射，关节突注射/内侧分支阻滞和射频消融，参与者从5个成本类别中选择：< 1000,1000- 4999,5000- 9999,10000- 19999，和bbb20,000。其他问题探讨了参与者对现金和留置权支付折扣的见解。结果：对于所有程序和参与者，最常见的值是1000 - 4999。神经外科选择的硬膜外值明显高于疼痛管理（P= 0.025）、PMR （P= 0.029）和PA/NP (P= 0.04)；关节突注射/内侧分支阻滞值高于PMR （P=.03）和PA/NPs (P=.01)；射频消融值高于PA/NPs （P= 0.02）。不接受留置权支付的医生在所有专业和程序中都显示出明显较低的价值。讨论：受访者报告的合理费用范围反映了医生期望与现有报销模式之间的差异，表明缺乏程序定价的标准化值。医疗保险的大约500 r e i m b u r s e m e n t f o r e p i d u r l i n j e c t i o n s n d f c e t i n j e c t i o n / m e d l b r n c h b l o c k s n d 1000射频消融术低于physician-perceived合理成本和膨胀的指控在lien-based案件中经常发现。相比之下，硬膜外注射的个人伤害费用可能高达20,000美元，只有2.9%的受访者选择这一费用类别。结论：这项调查突出了医疗保健提供者对合理费用的看法，可能有助于改进报销模式，确保法律程序的一致性，并为患者和提供者保持适当的可及性和补偿。

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Reasonable Cost for Procedures: An Anonymous Survey of Healthcare Providers.

Background: The cost of medical procedures in the United States varies dramatically depending on the payment system, including Medicare, Medi-Cal (California's Medicaid program), private insurance, or lien-based payment models used in personal injury cases. Cost discrepancies can discourage physician participation in Medicare and Medi-Cal, potentially limit access to care for vulnerable patient populations, and complicate the determination of proper compensation in court.

Objectives: To survey healthcare providers to determine reasonable costs for medical procedures, potentially aligning legal standards with healthcare costs.

Methods: An anonymous, 8-question electronic survey was distributed through Survey Legend® between February and September 2023 to providers in orthopedic surgery, neurosurgery, anesthesiology, interventional radiology (IR), physical medicine and rehabilitation (PMR), pain management, and physician assistants (PAs) or nurse practitioners (NPs). Three procedures-epidural injection, facet injection/medial branch block, and radiofrequency ablation-were included, with participants selecting from 5 cost categories: < $1000,$ 1000- $4999,$ 5000- $9999,$ 10000- $19999, a n d >$ 20,000. Additional questions explored participant insight into discounts for cash and lien-based payments.

Results: For all procedures and participants, the most common value was $1000 -$ 4999. Neurosurgery selected significantly higher epidural values than pain management (P=.025), PMR (P=.029), and PA/NP (P=.04); higher facet injection/medial branch block values than PMR (P=.03) and PA/NPs (P=.01); and higher radiofrequency ablation values than PA/NPs (P=.02). Physicians not accepting lien payments showed significantly lower values across all specialties and procedures.

Discussion: The range of reported reasonable costs by respondents reflects a discrepancy between physician expectations and existing reimbursement models, indicating a lack of a standardized value for procedural pricing. Medicare's estimated $500 r e i m b u r s e m e n t f o r e p i d u r a l i n j e c t i o n s a n d f a c e t i n j e c t i o n / m e d i a l b r a n c h b l o c k s a n d$ 1000 for radiofrequency ablation are below both physician-perceived reasonable costs and the inflated charges often found in lien-based cases. In contrast, personal injury billing can reach as high as $20,000 for an epidural injection, a cost category that only 2.9% of survey respondents chose.

Conclusion: This survey highlights healthcare providers' perceptions of reasonable costs for procedures, possibly assisting in refining reimbursement models, ensuring consistency in legal proceedings, and maintaining proper accessibility and compensation for patients and providers.

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来源期刊

Journal of Health Economics and Outcomes Research Medicine-Health Policy

CiteScore

3.00

自引率

0.00%

发文量

审稿时长

10 weeks