Usual, customary and reasonable

Usual, customary and reasonable

Usual, customary and reasonable (UCR) was an American method of generating health care prices,[1] described as "more or less whatever doctors decided to charge."[2] 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."[3]

Under this system, physician services were largely considered to be misvalued, with evaluation and management services being undervalued and procedures overvalued.[4] Third-party payers (public and private health insurance) advocated for an improved model instead of the UCR fees that led to "some egregious distortions".[2] In the mid 1980s, U.S. health care "payments for doing procedures had far outstripped payments for diagnosis".[2] For example, "doctors who spent an hour making a complex and lifesaving diagnosis were paid forty dollars; for spending a hour doing a colonoscopy and excising a polyp, they received more than six hundred dollars".[2] Costs for cataract surgery, which could be as high as $6,000 in 1985, "grew to consume 4% of Medicare's budget".[2] And despite technology that reduced the time required for the surgery by a factor of 4 to 6, costs did not decrease.[2]

The term is also used by lawyers for setting a reasonable retainer agreement.[citation needed]

See also

References

  1. ^ 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. http://content.healthaffairs.org/content/8/3/129.full.pdf. 
  2. ^ a b c d e f Gawande, Atul (2007). Better: A Surgeon's Notes on Performance. New York: Picador. p. 115. ISBN 0-312-42765-4. http://books.google.com/books?id=-EUba-LKZ04C&pg=PT83&dq=in+the+mid-eighties,+doctors+who+spent+an+hour+making+a+complex+and+lifesaving+diagnosis+were+paid+forty+dollars&hl=en&ei=M047TsqOF-fk0QHzxo2zCA&sa=X&oi=book_result&ct=result&resnum=1&ved=0CCwQ6AEwAA#v=onepage&q=in%20the%20mid-eighties%2C%20doctors%20who%20spent%20an%20hour%20making%20a%20complex%20and%20lifesaving%20diagnosis%20were%20paid%20forty%20dollars&f=false. 
  3. ^ 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. 
  4. ^ "Report to the Congress: Medicare Payment Policy". Medicare Payment Advisory Commission. March 2006. p. 137. http://www.medpac.gov/documents/Mar06_EntireReport.pdf. Retrieved July 18, 2011. 



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