Differential Reimbursement of Psychiatric Services by Psychiatrists and Other Medical Providers
Differential Reimbursement of Psychiatric Services by Psychiatrists and Other Medical Providers
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DOI：
10.1176/appi.ps.201700271
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发表时间：
2018-03-01
影响因子：
3.8
通讯作者：
Teich, Judith L.
中科院分区：
文献类型：
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作者：
Mark, Tami L.;Olesiuk, William;Teich, Judith L.
目的：鉴于低精神科医生参与保险网络，本研究探讨了精神科医生如何报销网络和网络下的商业保险相对于其他供应商为相同的诊断和service.Methods：支付私人保险索赔从2014年Truven健康分析MarketScan商业索赔和遭遇数据库进行了分析。该样本包括所有为380万名精神障碍患者提供的服务，这些患者被精神科医生、非精神科医生、心理学家、社会工作者或精神科护士作为主要诊断。作者确定了每种提供者类型提供的最常见的服务，按提供者类型和网络状态列出的服务的中位数报销和中位数自付费用（网内、网外）、网外服务费用占比。“评价和管理”精神科医生和非精神科医生最常向病人收取的两种服务费用是，为病人提供轻度到中度和中度到高度严重问题的服务。对于出现轻度至中度和中度至高度严重问题的服务，平均报销额为13%（66美元对76美元），减少20%（91美元对114美元）。如果服务由网络提供，精神科医生与非精神科医生相比，（100美元与78美元）和6%的高（122美元与115美元），分别为精神科医生与非精神科医生提供的服务outofnetwork.Conclusions：精神科医生收到较低的网络报销比非精神科医生为许多相同的服务。这可能导致精神科医生相对于其他提供者参与保险网络的程度较低，并对患者分担费用和获得精神科医生的机会产生影响。
Objective: Given low psychiatrist participation in insurance networks, this study examines how psychiatrists are reimbursed in network and out of network under commercial insurance relative to other providers for the same diagnoses and services.Methods: Paid private insurance claims from the 2014 Truven Health Analytics MarketScan Commercial Claims and Encounters Database were analyzed. The sample included all services billed for 3.8 million individuals with a mental disorder as the primary diagnosis by psychiatrists, nonpsychiatrist medical doctors, psychologists, social workers, or psychiatric nurses. The authors determined the most common services provided by each provider type, the median reimbursement and median out-of-pocket payment for the services by provider type and by network status (in or out of network), and the proportion of bills for services delivered out of network.Results: "Evaluation and management" services for presenting problems of low to moderate and moderate to high severity were the two procedures most frequently billed by psychiatrists and nonpsychiatrist medical doctors. The median reimbursement for services for presenting problems of tow to moderate and moderate to high severity was 13% tess ($66 versus $76) and 20% less ($91 versus $114). respectively, for psychiatrists versus nonpsychiatrist medical doctors if the services were provided in network but 28% higher ($100 versus $78) and 6% higher ($122 versus $115), respectively, for psychiatrists versus nonpsychiatrist medical doctors for services provided out of network.Conclusions: Psychiatrists receive lower in-network reimbursement than nonpsychiatrist medical doctors for many of the same services. This may contribute to psychiatrists lower participation in insurance networks relative to other providers and has implications for patient cost sharing and access to psychiatrists.