Analysis of hospital medical staff volume performance standards

Implementing a volume performance standard for medical staffs requires a number of technical analyses, including a casemix measure based on inpatient services and payment or performance adjustors at teh medical staff level. These technical analyses were provided in an earlier report, however, in measuring physician services (i.e., volume and intensity) per admission, the earlier report used deflated physician charges. This report uses the Medicare Fee Schedule (MFS) relative value unites (RVUs) in the same claims data to measure physician sercice volume and intensity. Deflated charges may reflect the historical distortion in the pre-MFS system resulting from physician charging practices. Consequently, the impact of using RVUs instead of charges in the development of the casemix measure and multivariate analyses of RVUs per admission is examined and compared to prior findings on deflated charges. Database construction and under development of the casemix measure are also reviewed. This research is conducted under a HCFA cooperative agreement #18-C-90038/3-01.