AAN Leads the Charge: Testing the Validity of Current Work Intensity Measures

March 14, 2011

The Centers for Medicare & Medicaid Services (CMS), the major payer of provider services, reimburses on the basis of the resource-based relative value (RBRVS) system. RBRVS determines reimbursement from three components: physician work (time and intensity), practice expenses, and professional liability.

Over the lifetime of the RBRVS system, the AMA's Relative Value Update Committee has developed open and reliable methods to measure physician work time, practice expense, and professional liability expense, but work intensity has been more difficult to measure.

On a 2008 recommendation of the Medical Economics and Management Committee, the AAN Board of Directors funded research into new ways to measure physician work intensity, and that initiative now is bearing fruit.

Questionnaires were used to measure the relative mental work intensity experienced by surgeons and nonsurgical specialists performing selective office visits or operations. An initial pilot project, proposed by researchers at the University of Cincinnati (UC), was expanded to a more statistically meaningful study when the AAN was joined by five other medical societies as sponsors.

The AAN collaborated with the American Academy of Dermatology on Phase I; and with several other specialties including the American Academy of Allergy, Asthma and Immunology, Joint Council of Allergy, Asthma and Immunology, American Academy of Family Physicians, and the American Psychiatric Association to fund phase II.

The UC study was completed in two phases. Phase I results were published earlier this year in Medical Care and indicated that work intensity was similar for surgeons and nonsurgeons: AAN in the News: Analysis Shows Stress on Clinicians Can be Effectively Measured

The research dovetails nicely with one of the key messages the AAN currently is sharing with Congress and the administration: the need to recognize cognitive specialties that spend most of their time evaluating and managing their patients as opposed to performing procedures.

Experts at Medicare and the Medicare Payment Advisory Commission (MedPAC)—a very influential congressional advisory committee—also have an interest in newer ways to evaluate physician work.

AAN member Marc Raphaelson, MD, FAAN, and AAN staff attended a meeting between the Cognitive Specialty Coalition and MedPAC in March. The AAN shared Phase I findings and explained that Phase II results currently are being submitted for publication. The AAN’s goal is to identify funding sources for further research into measurement and payment for physician work.

Check back often to AAN.com to learn more about this important work when Phase II results are published.

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