Early Health System Experiences with Collaborative Care (CoCM) Billing Codes: a Qualitative Study of Leadership and Support Staff
Early Health System Experiences with Collaborative Care (CoCM) Billing Codes: a Qualitative Study of Leadership and Support Staff
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DOI：
10.1007/s11606-019-05195-0
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发表时间：
2019-10-01
影响因子：
5.7
通讯作者：
Ratzliff, Anna D. H.
中科院分区：
文献类型：
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作者：
Carlo, Andrew D.;Baden, Andrea Corage;Ratzliff, Anna D. H.
背景技术背景：虽然协作护理（CoCM）是一种以证据为基础并被广泛采用的模式，但报销方面的挑战限制了全国范围内的实施工作。近年来，联邦医疗保险和其他支付者已经激活了CoCM特定代码，其主要目的是促进财务可持续性。目的：调查和描述联邦医疗保险CoCM代码的早期采用者和探索者的经验。设计和参与者：在2017年10月至2018年5月期间进行了15次访谈，其中25名受访者代表12家医疗保健机构和2名支付者。受访者包括双重登上医学/精神病学医生，精神科医生，初级保健医生（PCP），心理学家，注册护士，行政人员，和billing staff.APPROACH：一个半结构化的面试指南被用来解决医疗保健组织的特点，CoCM服务，患者同意，CoCM的业务组成部分，和CoCM计费流程。所有的采访都被记录，转录，编码，并使用由研究团队共同进行的内容分析方法进行分析。关键结果：成功的计费需要关键的跨学科利益相关者的支持。在规划CoCM计费实施时，一些组织聘请了持牌临床社会工作者（LICSW）作为行为健康护理经理，以最大限度地提高计费灵活性。受访者报告了一些与同意有关的困难，但这些不是主要障碍。对CoCM代码进行计费所需的工作流程变更（例如，跟踪累计治疗分钟数，每月一次的代码输入）被描述为艰巨的，但也激发了创造性的解决方案。由于CoCM代码将精神病顾问的工作纳入初级保健的一次支付，组织采用了部门间分类帐转移等策略。当当地付款人组合的变化带来挑战时，一些组织专门使用CoCM代码，而另一些组织则选择使用CoCM和传统的按服务收费（FFS）代码的混合。对于大多数组织，这是很重要的，以证明财务可持续性的CoCM codes.CONCLUSIONS：与精心策划，持久性，和广泛的组织买入，成功利用新的可用的FFS CoCM计费代码是可以实现的。
BACKGROUND: Although collaborative care (CoCM) is an evidence-based and widely adopted model, reimbursement challenges have limited implementation efforts nationwide. In recent years, Medicare and other payers have activated CoCM-specific codes with the primary aim of facilitating financial sustainability.OBJECTIVE: To investigate and describe the experiences of early adopters and explorers of Medicare's CoCM codes.DESIGN AND PARTICIPANTS: Fifteen interviews were conducted between October 2017 and May 2018 with 25 respondents representing 12 health care organizations and 2 payers. Respondents included dually boarded medicine/psychiatry physicians, psychiatrists, primary care physicians (PCPs), psychologists, a registered nurse, administrative staff, and billing staff.APPROACH: A semi-structured interview guide was used to address health care organization characteristics, CoCM services, patient consent, CoCM operational components, and CoCM billing processes. All interviews were recorded, transcribed, coded, and analyzed using a content analysis approach conducted jointly by the research team.KEY RESULTS: Successful billing required buy-in from key, interdisciplinary stakeholders. In planning for CoCM billing implementation, several organizations hired licensed clinical social workers (LICSWs) as behavioral health care managers to maximize billing flexibility. Respondents reported a number of consent-related difficulties, but these were not primary barriers. Workflow changes required for billing the CoCMcodes (e.g., tracking cumulative treatment minutes, once-monthly code entry) were described as arduous, but also stimulated creative solutions. Since CoCM codes incorporate the work of the psychiatric consultant into one payment to primary care, organizations employed strategies such as inter-departmental ledger transfers. When challenges arose from variations in the local payer mix, some organizations billed CoCM codes exclusively, while others elected to use a mixture of CoCM and traditional fee-for-service (FFS) codes. For most organizations, it was important to demonstrate financial sustainability from the CoCM codes.CONCLUSIONS: With deliberate planning, persistence, and widespread organizational buy-in, successful utilization of newly available FFS CoCM billing codes is achievable.