Medicare physician reimbursement policy and type of service volume sensitivity

The current Medicare physician reimbursement policy and methodology are dysfunctional, producing neither the necessary financial nor quality outcomes. The implications are significant in both the public and private sectors.;This dissertation addresses Medicare physician reimbursement policy from two perspectives: (1) the inherent problem of increasing physician medical service volume and (2) the larger policy question addressing the appropriateness of the Medicare physician reimbursement system for the expanded role proposed by health care reformers. The examination and results of the inherent influence of reimbursement on service volumes expose a fundamental structural flaw of the current Medicare physician reimbursement system, precluding its appropriateness for an expanded role in health care reform.;The contemporary inherent problem indicates that Medicare physician medical service volume increases are at the root of the current rising expenditure trends. This inherent problem of increasing volume poses the specific research question: Do specific types of physician medical services exhibit potential for reimbursement interventions to curb the volume escalation in utilization? The investigation of the current Medicare physician reimbursement system will focus on this inherent problem of increasing volume. Through this lens, the sensitivity of specific types of services is examined.;Examining the inherent incentives and model findings, the concluding chapter addresses both the potential for interim short-term adaptation and presents conclusions and recommendations regarding this policy question: Is the current Medicare physician reimbursement system appropriate for the transition to an expanded role of consolidating financing or becoming the single-payer solution for health care reform?;The conclusions and recommendations sustain both the inherent volume hypothesis and the policy hypothesis, concluding that: The current Medicare physician reimbursement system is not appropriate for the expanded role proposed by health reformers. Furthermore, it is asserted that the current Medicare physician reimbursement system is dysfunctional and beyond the point for definitive repair. Medicare policy-makers and administrators must change tactics to control utilization and cost escalation. Medicare physician reimbursement reform cannot be accomplished in isolation.;Keywords: physician reimbursement, CPT volume sensitivity, health care reform, Medicare Part B, RBRVS.