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 !(right lobectomy) 0.520 0.083 0.041 0.192 0.543** 0.656 3
 !(left lobectomy) 0.639** 0.023 -0.145 0.562** 0.369** 0.648 4
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 !"#$%(choledocholithotomy) 0.375* -0.025 0.145** 0.349** 0.409** 0.651 8
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 !"#(radical subtotal gastrectomy) 0.204 0.114 0.164 0.473** 0.228 0.670 10
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 !"#$(diatal pancreactomy) 0.236 0.082 0.057 0.180 0.638** 0.594 19
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 !"#$(total gastrectomy) 109 714 3.5% 115 188 1.9%

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 !"#$%&'()*# 116 451 3.3% 122 117 2.9%

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 !"#$(diatal pancreactomy) 108 605 3.5% 114 158 2.8% 19
 !"(splenectomy) 115 435 3.7% 120 103 3.0% 20
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intestine and anastomosis)

21
 !"(appendectomy), uncomplicated 118 184 3.6% 125 48 2.8%

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 (Enterolysis for intestinal obstruction) 113 360 3.6% 121 114 2.8%

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27
 !"(Femoral hernioplasty) 9 133 7.5% 9 56 4.2%

28
 !"(umbical hernioplasty) 9 107 13.7% 10 46 5.5%

29
 !"#(incacerated hernioplasty) 9 160 6.9% 10 72 5.3%

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 !"#$(extended right lobectomy) 9 1261 3.8% 10 266 2.7%

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N Mean SE N Mean SE 32
 !"#(tri-segmentectomy) 9 1000 3.3% 10 215 3.5% 33
 !"#(two segmentectomy) 9 850 3.7% 10 184 2.7% 34
 !"#(one segmentectomy) 9 711 5.1% 10 151 5.4% 35
 !"#$%(MRM) 9 514 8.5% 10 144 7.5%

36
 !"(breast preserving surgery) 9 407 12.0% 10 110 7.5%

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 !"#$(simple mastectomy) 9 327 9.5% 10 93 7.5% 38
 !"#$(total thyroidectomy) 9 572 6.9% 10 164 6.6% 39
 !"#(thyroidectomy) 9 423 8.4% 10 108 7.3% 40
 !"#$(subtotal thyroidectomy) 9 384 8.3% 10 97 7.8% 41
 !"#$(parathyroidectomy) 9 449 6.7% 10 108 6.1% 42
 !"# !$% 9 650 8.7% 10 166 8.8%

(choledochjejunostomy and gastro jejunostomy)

43
 !(kidney transplantation) 5 1320 15.0% 6 272 11.3% 44
 !(liver transplantation) 4 2800 7.7% 5 562 10.7% 45
 !(pancreas transplantation) 4 2075 7.2% 5 478 11.9% 46
 !"#$% 9 46 20.3% 10 15 21.1% 47
 !"#$%&' 8 45 18.9% 9 38 70.2% 48
 !"#$%& 7 49 19.3% 9 15 17.8% 49
 !" Intra-operative echo 9 66 12.1% 10 17 24.2% 50
 !"#$ Fiber choledochoscopy 8 78 16.8% 9 27 14.8% 51
 !"#$%& 6 160 11.5% 9 61 13.7% 52
 !" Laparoscopy 9 134 19.7% 9 47 7.8% 53
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 Operative cholangiography 9 83 15.3% 10 25 12.6%

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 !"#$ Partial mastectomy
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 !"#$%&' unilateral 9 140 12.6% 10 43 7.4%

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 !"#$ Subcutaneous mastectomy 8 323 10.0% 10 76 8.3%

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 !"#$%&'( Breast tumor biopsy 9 94 4.6% 10 29 6.5%

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 !" Splenorrhaphy 8 359 7.4% 9 106 8.5% 59
 !"#$% 9 294 8.4% 10 75 6.3% 60
 !"#$%&'()*+,#$ 9 611 4.6% 10 151 5.9% with vagotomy 61
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64
 !"#$%&'() Highly selective vagotomy 9 424 7.9% 10 115 6.0%

65
 !"#$%&' ()!" Gastrectomy, 9 930 4.8% 10 257 3.9%

total, with splenectomy or partital pancreatectomy

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 !"#$ Resection of retained antrum, 9 477 7.3% 10 140 9.0%

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72
 !"#$ Repair of intestinal perforation 9 243 7.1% 10 66 8.1%

73
 !"#$ 9 186 3.8% 10 50 3.2% 74
 !"# Partial hepatectomy 9 568 4.6% 10 113 3.6% 75

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 !"# $%"&%' 9 493 5.3% 10 145 6.1%

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 !"#$% Body partial pancreatectomy 9 564 6.1% 10 152 3.3%

81
 !"#$%&'()*+,-. 9 497 5.8% 10 129 5.4%

82
 !"#$ Pancreatectomy subtotal 9 598 7.1% 10 166 5.7%

83
 !"#$ Pancreatico-Jejunostomy 8 739 9.1% 10 144 8.6%

84
 !"#$%&'() without bowel resection 9 213 6.3% 10 91 7.0%

85
 !"#$%&'() with bowel resection 9 272 16.7% 10 111 6.6%

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 !"#$ Becker, E. R., Dun, D., Braun, P., & Hsiao, W. C. (1990). Refinement and expansion of the Harvard Resource-Based Relative Value Scale: The second phase. AJPH, 80, 799-803. Gallagher, P. E., Klemp, T., & Smith, S. L. (2001).

Medicare RBRVS: The physicians' guide 2001. 5 t h e d . C h i c a g o : A m e r i c a n M e d i c a l

Association.

Hsiao, W. L., Braun, P., & Becker, E. R. (1988a). Resource-Based Relative Values. An overview.

JAMA, 260, 2347-2353.

Hsiao, W. C., Braun, P., Becker, E. R., Causino, N., Cohen, W. S., Couch, N. P., Denburg, J., Dunn, D. L., Frazier, H. S., Freshour, M. A. C.,

Jernigan, C. G., Kelly, N. L., Ketcham, T. R., Leape, L. L., McCabe, M. D., Rodriguez, E., Stamenovic, E., Verrilli, D. K., & Yntema, D. B. (1990). A national study of

resource-based relative value scales for physician services. Phase II final report to the Health Care Financing Administration. HCFA

con-tract No. 18-C-98795/1-03. Boston, MA: Harvard School of Public Health.

Hsiao, W. C., Braun, P., Becker, E., Causino, N., Couch, N. P., DeNicola, M., Dunn, D., Kelly, N. L., Ketcham, T., Sobol, A., Verrilli, D., & Yntema, D. B. (1988b). A national study of

resource-based relative value scales for phy-sician services. Final report to the Health Care Financing Administration. HCFA

con-tract No. 17-C-98795/1-03. Boston, MA: Harvard School of Public Health.

Hsiao, W. C., Braun, P., Becker, E. R., & Thomas, S. R. (1987). The Resource-Based Relative Value Scale-toward the development of an al-ternative physician payment system. JAMA,

258, 799-802.

Hsiao, W. C., Braun, P., Dunn, D., Becker, E. R., DeNicola, M., & Ketcham, T. R. (1988c). Re-sults and policy implications of the Resource-Based Relative-Value Study (Special Report).

N. Engl. J. Med., 319, 881-888.

Hsiao, W. C., Braun, P., Kelly, N. L., & Becker, E. R.(1988d). Results, potential effects, and implementation issues of the Resource-Based Relative Value Scale. JAMA, 260, 2429-2438. Hsiao, W. C., Braun, P., Yntema, D., & Becker, E. R. (1988e). Estimating physicians’ work for a Resource-Based Relative-Value (special report). N. Engl. J. Med., 319, 835-841. Hsiao, W. C., Yntema, D. B., Braun, P., Dunn, D.,

& Spencer, C.(1988f). Measurement and analy-sis of intraservice work. JAMA, 260, 2361-2370.

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JAMA, 261, 2382-2385.

Levy, J. M., Borowitz, M. J., Jencks, S. F., Kay, T. L., & Williams, D. K. (1990). Impact of the Medicare Fee Schedule on payments to physicians. JAMA, 264, 717-722.

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Physician Workload Relative Value Scale and Procedure

Duration for 86 Gastroenterologic Surgery Treatments

in Taiwan

Hsiu-Ling Chen

1

Ming-Chin Yang

2

Hsyien-Chia Wen

3

Wen Jiun Huang

4

Herng-Chia Chiu

5

Hui-Chuan Hsu

6

Chih-Liang Yaung

7

Abstract

Objectives: This study investigated the workload Relative Value Scale (work-RVS) and the length

of time for various gastroenterologic (GI) surgery procedures in Taiwan. The studies results may form the basis for reasonable resource-based assessment of future reimbursements to the hospitals.

Methods: Acting on a recommendation from the Taiwan Surgical Society of Gastroenterology, a

technical consulting group (TCG) was organized to select the specific services/procedures (S/Ps) for investigation and the reference services/procedure (S/P). Two-round Delphi technique questionnaires were distributed to society members; respondents were asked to magnitude estimate the work-RVS and the time required for each S/P. The TCG then evaluated the questionnaire results to estimate work-RVS and time requirements for non-surveyed S/Ps. Finally, statistical analysis was applied to assess the reliability and validity of the study.

Results: The work-RVSs and the duration for 86 GI surgical procedures were established. The

opinions of the GI surgeons were strongly correlated each other. There were no significant differences for medical center, regional hospital, local hospital or clinic for work-RVS and time required for the surveyed procedures. Multiple regression analysis for the procedures investigated demonstrated highly adjusted R2. It means that physician’s time, mental effort and judgment, technical skill and physical effort, and level of stress can be suitable explained by work-RVS.

Conclusion: (1) The magnitude estimate method, Delphi technique and using the method of a TCG

are potentially useful tools for establishing the common work-RVS and duration of GI procedures. (2) Gastroenterology surgeons had a high degree of agreement for work-RVS and duration of each procedure. (3) Work-RVS proved to be an excellent estimator of physician time, mental effort and judgment, technical skill and physical effort, and degree of stress involved in performing GI surgical procedures.

Key Words: Relative value scale, procedure time, gastroenterology surgery, G. I. surgery

1

Senior administrator assistant, Mackay Memorial Hospital.

2

Associate professor, Institute of Health Care Organization Administration, College of Public Health, National Taiwan University.

3

Assistant professor, Department of Health Care Administration, Taipei Medical University.

4

Administrator assistant, ChungShan Medical University Hospital.

5

Associate professor, Graduate Institute of Healthcare Administration, Kaohsiung Medical University.

6

Assistant professor, Department of Health Administration, Taichung Health and Management University.

7

Professor, Department of Health Administration, Taichung Health and Management University. Received: Nov. 22, 2004 Revised: Jan. 17, 2005 Accepted: Feb. 3, 2005

Address Correspondence to: Chih-Liang Yaung Department of Health Administration, Taichung Health and Management University, Taichung, Taiwan (R.O.C.)