Usual, customary and reasonable
Usual, customary and reasonable (UCR) was an American method of generating health care prices, described as "more or less whatever doctors decided to charge." According to Steven Schroeder, Wilbur Cohen inserted UCR into the Social Security Act of 1965 "in an unsuccessful attempt to placate the American Medical Association."
Under this system, physician services were largely considered to be misvalued, with evaluation and management services being undervalued and procedures overvalued. Third-party payers (public and private health insurance) advocated for an improved model instead of the UCR fees that led to "some egregious distortions". In the mid-1980s, U.S. health care "payments for doing procedures had far outstripped payments for diagnosis". For example, "doctors who spent an hour making a complex and lifesaving diagnosis were paid forty dollars; for spending an hour doing a colonoscopy and excising a polyp, they received more than six hundred dollars". Costs for cataract surgery, which could be as high as $6,000 in 1985, "grew to consume 4% of Medicare's budget". And despite technology that reduced the time required for the surgery by a factor of 4 to 6, costs did not decrease.
For dentists the American Dental Association defines a Usual & Customary Fee as "the fee an individual dentist most frequently charges for a specific dental procedure independent of any contractual agreement. It is always appropriate to modify the fee based on the nature and severity of the condition being treated and by any medical or dental complications or unusual circumstances." ADA News, January 17, 2011.
- Glaser WA (1989). "The politics of paying American physicians". Health Aff (Millwood) 8 (3): 129–46. doi:10.1377/hlthaff.8.3.129. PMID 2676818.
- Gawande, Atul (2007). Better: A Surgeon's Notes on Performance. New York: Picador. p. 115. ISBN 0-312-42765-4.
- Steven A. Schroeder (April 2011). "Personal reflections on the high cost of American medical care: Many causes but few politically sustainable solutions". Archives of Internal Medicine 171 (8): 722–727. doi:10.1001/archinternmed.2011.149. PMID 21518938.
- "Report to the Congress: Medicare Payment Policy". Medicare Payment Advisory Commission. March 2006. p. 137. Retrieved July 18, 2011.
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