Variation in Medicare's local coverage policies: content analysis of local medical review policies.
Variation in Medicare's local coverage policies: content analysis of local medical review policies.
复制标题
医疗保险当地承保政策的变化：当地医疗审查政策的内容分析。
DOI：
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发表时间：
2005
影响因子：
3.2
通讯作者：
D. Wholey
中科院分区：
文献类型：
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作者：
S. Foote;R. Halpern;D. Wholey
目的
评估Medicare当地医疗审查政策内容的变化。
研究设计
6项病例研究，按诊断代码、手术代码和使用适应症比较覆盖政策的差异。
方法
2001年5月31日下载了张贴在医疗保险和医疗补助服务中心网站上的48份承运人合同（n = 5213）的所有承运人政策。数据集中的所有政策都是根据一种类型进行编码的：新技术（NT），新技术的扩展（TE）和广泛使用的程序的利用管理（UM）。我们确定了针对相同程序或技术的政策。我们要求每个案例研究中至少有20个独立的政策，以便进行有意义的比较。我们从每种政策类型（NT、TE和UM）中随机选择了1例诊断性病例研究和1例治疗性病例研究。
结果
鉴于以前对当地运营商的研究，我们希望在每个案例研究中找到政策之间的差异。然而，我们发现，覆盖NT和TE类型的政策之间存在很大的相似性。我们在UM类型的案例研究中发现了更多的变化。
结论
医疗保险立法要求医疗保险中更大的覆盖政策一致性。这种对政策内容变化的分析是对医疗保险当地覆盖过程变化的更大研究的一部分，提供了有关政策内容差异的数据。政策改革应反映本研究结果所建议的政策变化的性质和原因。
OBJECTIVE
To assess variation in the content of Medicare's local medical review policies.
STUDY DESIGN
Six case studies to compare differences in coverage policies by diagnosis codes, procedure codes, and indications for use.
METHODS
All carrier policies from 48 carrier contracts (n = 5213) posted to the Centers for Medicare & Medicaid Services Web site were downloaded on May 31, 2001. All policies in the data set were coded based on a typology: new technology (NT), extensions of new technology (TE), and utilization management (UM) of widely used procedures. We identified policies addressing the same procedure or technology. We required at least 20 separate policies in each case study to allow meaningful comparisons. We randomly selected 1 case study of a diagnostic and 1 for a treatment modality from each policy type (NT, TE, and UM).
RESULTS
Given previous research on local carriers, we expected to find variations among policies in each case study. We found substantial similarity, however, among policies covering the NT and TE types. We found significantly more variation among our UM-type case studies.
CONCLUSIONS
Medicare legislation has called for greater coverage policy consistency in Medicare. This analysis on variation in policy content, part of a larger study on variation in Medicare's local coverage process, provides data on policy content differences. Policy reform should reflect the nature of and reasons for policy variation as suggested by the findings of this research.