CMS a indicated that it will review the ACS data, and it has proposed to use them in the construction of the practice expense adjustment factor in the future. A full work adjustment would mean that variations in earnings would reflect the full extent of differences in cost of living, as attenuated by area amenities. In practice, budget neutrality requires that the total amount of payment be unaffected by new adjustments, so that any adjustment upward for one payment area must be paid for by a downward adjustment for other areas. When the geographic adjuster for physician work was originally developed, it was based on nonphysician professional earnings that ranged from 28 percent above the national average, in Manhattan, New York, to 16 percent below the national average, in rural Missouri Zuckerman and Maxwell, The expanded set of occupations will be a better reflection of the current workforce and a broader range of health professions, which will help to improve accuracy of the adjustment.

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While the committee strongly supports an empirical approach to determining the work adjustment, it also acknowledges that it is impossible to determine in advance how much predictive power the most appropriate statistical model may attain.

The MP GPCI is based on MP premium data for 25 physician specialties collected from state insurance commissioners and private insurers gppci are averaged for each payment area. This chapter describes the history, intent, and evolution of the geographic practice cost indexes GPCIs to provide background and context for the committee’s findings and recommendations about improving the accuracy of payment.

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They also collected and reported data differently e. Premium data from Mississippi and Puerto Rico were not collected. Centers for Medicare and Medicaid Services; b.

By statute, any changes to the GPCIs that do not explicitly receive additional funding must be budget neutral. The MEI cost shares are updated annually to meet a statutory requirement, which states that any prevailing charge levels beginning after June 30, may not exceed the level from the previous year tpci to the extent that the Secretary find that a higher level is justified by year-to-year economic changes based on appropriate economic index data P.


The committee’s discussion and recommendations about revising payment area configurations are the subjects of Chapter 2.

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Based on the limitations associated with each data source, such as low response rates, small sample sizes, and sample bias, the committee concluded that all of these sources would be imperfect or geographically incomplete proxies for variation in physician office rental costs. The statistical analysis would then be a linear regression 5 to determine which occupations’ earnings best track physician earnings, then creating an adjustment index based on geographic variation in earnings in the other occupations.

However, in lateadditional ACS data became publicly available, offering certain advantages over BLS data, including a higher response rate, larger sample size including wage data at the zip code leveland more frequent data collection see Table When the geographic adjuster for physician work was originally developed, it was based on nonphysician professional earnings that ranged from 28 percent above the national average, in Manhattan, New York, to 16 percent below the national average, in rural Missouri Zuckerman and Maxwell, Resident wages are also included.

A resource for residents, practicing physicians, and other health care professionals. The committee’s phase 1 report addresses geographic differences in input prices, focusing on improving accuracy by relying on the best possible input price measures from an independent source. Seller assumes all responsibility for this listing.

One approach is to calculate an index to represent the predicted value for physician compensation from the regression model. Email to friends Share on Facebook – opens in a new window or tab Share on Twitter – opens in a new window or tab Share on Pinterest – opens in a new window or tab Add to watch list. Medicare pays nurse practitioners, physician assistants, and clinical nurse specialists at 85 percent of the physicians’ fees, after the deductible is met MedPAC, Furthermore, the total weight given to all occupations would also be determined empirically through the magnitude of the coefficients; thus, the choice of a one-quarter work GPCI or something larger or smaller would be determined through an objective empirical procedure.

The recommendations presented in this chapter relied on many of the same data sources that were used for analyses presented in other chapters. The approach is based on the logic of compensating wage differentials, which suggests that anything less than a full cost of living adjustment should be offset by the region’s desirable amenities.


Estimating physicians’ work for a resource-based relative-value scale. Physicians incomes in rural and urban America. External 2 2dBi Detachable Antennas. The appropriateness of using these data rests on the assumption that residential rents and commercial office rents are influenced by similar factors—for example, land scarcity and population density—although the lack of publicly available commercial data makes it difficult to fully test this assumption.

Comparable to the analyses and recommendations about the Hospital Wage Index HWIthe committee concluded that independent data that reflect market prices faced by providers are more appropriate than provider data on costs paid, because actual costs also reflect business decisions that are not necessarily an accurate reflection of input prices. Another major source of disagreement is whether the geographic adjusters should be used as policy levers to help influence provider supply, particularly in nonmetropolitan areas.

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Providers in medically underserved urban areas may also lack necessary supports—translators, for example Flores,which increases the time required to communicate with patients. Another study found that primary care physicians general practitioners, family physicians, internists, and pediatricians in nonmetropolitan areas earned about 5 percent less than their urban counterparts did, after making similar adjustments to those made in the HSC study Weeks and Wallace, All industry wage data have the largest sample size, but the committee is concerned that the large sample does not represent physician offices.

Learn more – opens in a new window or tab. County level data file. Since the gcpi of the PFS and the RBRVS inthere have been differences of opinion about whether and how to make geographic adjustments to physician work payments and how much the adjustments should be.