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Resource Based Relative Value Scale for children—comparison of pediatric and adult cardiology work values

Published online by Cambridge University Press:  19 August 2008

Arthur Garson Jr*
Affiliation:
From the Pediatric Cardiology Committee, Fairfax
Michael J. Wolk
Affiliation:
Economics of Health Care Committee, Fairfax
Sandra B. Morrin
Affiliation:
Economics of Health Care Committee, Fairfax
William Gold
Affiliation:
American College of Cardiology, Bethesda, the Section on Cardiology, the American Academy of Pediatrics, Elk Grove Village and from Lewin VHI, Fairfax
Michael Dickstein
Affiliation:
American College of Cardiology, Bethesda, the Section on Cardiology, the American Academy of Pediatrics, Elk Grove Village and from Lewin VHI, Fairfax
Allen Dobson
Affiliation:
American College of Cardiology, Bethesda, the Section on Cardiology, the American Academy of Pediatrics, Elk Grove Village and from Lewin VHI, Fairfax
*
Dr. Arthur Garson, Jr., Box 3090, Duke University Medical Center, Durham, North Carolina 27710USA.

Abstract

Current procedural terminology codes generally do not distinguish between patients based on age or etiology of disease. As standardized payment schedules based upon such codes are being developed, the precise definition of a “typical” patient for each code becomes increasingly important. Since small size, young age, or presence of complex congenital disease could potentially render the work value of a physician's service different between children and adults, a study was jointly undertaken by the American College of Cardiology and the Cardiology Section of the American Academy of Pediatrics to compare relative work for the most commonly used Current Procedural Terminology codes in pediatric cardiology. A Technical Advisory Panel chose codes for evaluation and wrote clinical descriptors for each service. A separate rating panel of eight pediatric cardiologists (academic and private practice) and three adult cardiologists participated in a mail survey assigning work values to each service relative to current Health Care Financing Administration adult relative value units. The Panel then met and employed a modified Delphi process to arrive at consensus values. Of the 20 codes rated, only five were determined to be similar to adults. The pediatric median values were an average of 44% higher than the adult values (general cardiology codes 8% higher, echocardiography 90%, catheterization 49%, electrophysiology 35%). Thus, work values for cardiology were found to be different between children and adults in 75% of services assessed. The magnitude of these differences should be confirmed in a broader study. The Current Procedural Terminology Committee of the American Medical Association should consider, at a minimum, creating modifiers by specific age for certain procedures. Further study of the quantitative difference between services performed in adults and children is warranted.

Type
Health Policy
Copyright
Copyright © Cambridge University Press 1995

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References

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