Evidence-based imaging guidelines and Medicare payment policy.
Evidence-based imaging guidelines and Medicare payment policy.
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循证成像指南和医疗保险支付政策。
DOI：
10.1111/j.1475-6773.2007.00802.x
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发表时间：
2008
影响因子：
3.4
通讯作者：
McKay,NiccieL
中科院分区：
文献类型：
--
作者：
Sistrom,ChristopherL;McKay,NiccieL
目的：这项研究考察了神经成像程序的循证适当性标准与医疗保险支付决定之间的关系。主要的研究问题是，随着适当性水平的提高，联邦医疗保险是否更有可能为成像程序付费。数据来源。美国放射学会神经成像适当性标准(ACRAC)、ICD-9-CM代码、CPT代码以及佛罗里达州和康涅狄格州联邦医疗保险B部分承运人的支付决定。研究设计。神经成像适当性标准和联邦医疗保险B部分支付政策的横断面研究。除了描述性和双变量统计外，对支付决定(是或否)进行了多变量Logistic回归。数据收集方法：使用美国放射学会关于神经成像的适当性标准(ACRAC)文件、ICD-9-CM代码和CPT代码来创建2510种医疗条件/成像程序组合，以及相关的适宜性分数(编码为低/中/高)。主要发现。随着适合性水平的增加，更多的医疗条件/成像程序组合被支付(低=61%，中=70%，高=74%)。Logistic回归表明，中等适当性的医疗条件/成像程序组合比适宜性分数较低的其他类似组合高48%(优势比为95%的CI=1.19-1.84)。在适当性高水平和低水平之间支付的优势比为2.25(95%CI：1.66-3.04)。结论：医疗保险可以通过利用现有的临床指南、适当性标准和其他循证实践的权威资源来改进其支付决定。这样的方法将为提供者提供与最佳实践医学相一致的财务激励。特别是，Medicare应该审查和更新其支付政策，以反映当前关于相同医疗条件下替代成像程序的适当性的信息。
Objective.This study examines the relationship between evidence‐based appropriateness criteria for neurologic imaging procedures and Medicare payment determinations. The primary research question is whether Medicare is more likely to pay for imaging procedures as the level of appropriateness increases.Data Sources.The American College of Radiology Appropriateness Criteria (ACRAC) for neurological imaging, ICD‐9‐CM codes, CPT codes, and payment determinations by the Medicare Part B carrier for Florida and Connecticut.Study Design.Cross‐sectional study of appropriateness criteria and Medicare Part B payment policy for neurological imaging. In addition to descriptive and bivariate statistics, multivariate logistic regression on payment determination (yes or no) was performed.Data Collection Methods.The American College of Radiology Appropriateness Criteria (ACRAC) documents specific to neurological imaging, ICD‐9‐CM codes, and CPT codes were used to create 2,510 medical condition/imaging procedure combinations, with associated appropriateness scores (coded as low/middle/high).Principal Findings.As the level of appropriateness increased, more medical condition/imaging procedure combinations were payable (low = 61 percent, middle = 70 percent, and high = 74 percent). Logistic regression indicated that the odds of a medical condition/imaging procedure combination with a middle level of appropriateness being payable was 48 percent higher than for an otherwise similar combination with a low appropriateness score (95 percent CI on odds ratio=1.19–1.84). The odds ratio for being payable between high and low levels of appropriateness was 2.25 (95 percent CI: 1.66–3.04).Conclusions.Medicare could improve its payment determinations by taking advantage of existing clinical guidelines, appropriateness criteria, and other authoritative resources for evidence‐based practice. Such an approach would give providers a financial incentive that is aligned with best‐practice medicine. In particular, Medicare should review and update its payment policies to reflect current information on the appropriateness of alternative imaging procedures for the same medical condition.
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影响因子：
1.7
作者：
M. Tuttle;S. J. Nelson
通讯作者：
S. J. Nelson
DOI：
--
发表时间：
1992
期刊：
Administrative radiology : AR
影响因子：
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作者：
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通讯作者：
E. Walsh
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影响因子：
4.5
作者：
C. Sistrom
通讯作者：
C. Sistrom
影响因子：
3.6
作者：
A. Barnato;A. Garber
通讯作者：
A. Garber
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。
影响因子：
3.2
作者：
S. Foote;R. Halpern;D. Wholey
通讯作者：
D. Wholey