However, when developing the RBPE RVUs, average practice expenses were estimated in both the facility and non-facility settings, for the services that Medicare determined would have a site of service differential.
Our focus is in identifying the additional services with site of service payment differentials and seeing whether changes occurred in setting choice and in RVU volume during the period that site of service differentials were added and that RBPE RVUs were implemented.
We then analyzed aggregate growth in Medicare physician practice expense and total RVU volume (the latter being a counterpart to Medicare spending on physician services) and the sources of that growth in terms of: (1) shifts in site of service, (2) changes due to shifting from charge-based to RBPE RVUs, and (3) changes in the quantity and mix of services furnished.
We then decomposed the change in practice expense and total RVU volume over the 6 years into three factors: (1) changes due to site of service, (2) changes due to the implementation and refinement of RBPE RVU values, and (3) changes in the quantity and mix of services furnished over the period.
Second, we identified RVU volume change due to the shift from charge-based to RBPE RVUs using the following calculation: Equation 2 (Resource-Based RVU Component):
The change in RVU volume resulting from Equation 2 quantifies the change in RVU volume due to the shift from charge-based to RBPE RVUs.
(2) A lean supply chain uses lean manufacturing principles and RBPE. RBPE helps companies respond to demand by determining the average rate of demand for both end products and component parts.
Under RBPE, demand variation is accommodated with changes in capacity rather than inventory.
To understand how RBPE and other lean manufacturing techniques can be integrated into different product strategies, we've classified products in the following way:
Initially, it would seem that RBPE techniques could not be applied to these products because using forecasts to create inventory in anticipation of demand runs counter to RBPE.
These products need to use RBPE techniques; otherwise, their manufacturers will struggle with long leadtimes and inefficient use of capacity.