Professional Fee Ratios for US Hospital Discharge Data
Professional Fee Ratios for US Hospital Discharge Data
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DOI：
10.1097/mlr.0000000000000410
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发表时间：
2015-10-01
期刊：
影响因子：
3
通讯作者：
Annest, Joseph L.
中科院分区：
文献类型：
--
作者：
Peterson, Cora;Xu, Likang;Annest, Joseph L.
背景：美国医院出院数据集通常报告设施费用（即，食宿费），不包括专业费用（即，主治医生的费用）。目的：我们的目的是估计专业费用比率（PFR）按年和临床诊断用于基于医院出院数据的成本分析。受试者：受试者包括一个回顾性队列的Truven Health MarketScan 2004 - 2012住院（n = 23，594，605）和治疗和释放急诊科（艾德）访视（n = 70，771，576）。措施：PFR每次访视评估为总支付除以仅设施支付。研究设计：使用普通最小二乘回归模型控制选定的特征（即，患者年龄，合并症等），我们根据健康保险类型计算了入院的调整后平均PFR（商业或医疗补助）每年总体和主要诊断类别（MDC）、诊断相关组、医疗保健成本和利用项目临床分类软件和主要国际疾病分类（第9版，临床修改）（ICD-9-CM）诊断，以及每年总体和MDC和主要ICD-9-CM诊断的艾德访视。2012年入院（包括之前的艾德访视）的校正平均PFR为1.264（95% CI，1.264，1.265）对于商业保险住院（n = 2，614，326）和1.177（1.176，1.177）用于医疗补助入院（n = 816，503），表明专业支付使每次入院支付总额分别平均增加26.4%和17.7%，高于仅机构支付。2012年艾德访视的校正后平均PFR为1.286（1.286，1.286），商业保险访视（n = 8，808，734）和医疗补助访视（n = 2，994，696）分别为1.440（1.439，1.440）。补充表报告2004 - 2012年年度PFR估计临床classification.Conclusions：建议调整专业费用时，医院设施只有财务数据从美国出院数据集用于估计医疗保健费用。
Background:US hospital discharge datasets typically report facility charges (ie, room and board), excluding professional fees (ie, attending physicians' charges).Objectives:We aimed to estimate professional fee ratios (PFR) by year and clinical diagnosis for use in cost analyses based on hospital discharge data.Subjects:The subjects consisted of a retrospective cohort of Truven Health MarketScan 2004-2012 inpatient admissions (n=23,594,605) and treat-and-release emergency department (ED) visits (n=70,771,576).Measures:PFR per visit was assessed as total payments divided by facility-only payments.Research Design:Using ordinary least squares regression models controlling for selected characteristics (ie, patient age, comorbidities, etc.), we calculated adjusted mean PFR for admissions by health insurance type (commercial or Medicaid) per year overall and by Major Diagnostic Category (MDC), Diagnostic Related Group, Healthcare Cost and Utilization Project Clinical Classification Software, and primary International Classification of Diseases, 9th Edition, Clinical Modification (ICD-9-CM) diagnosis, and for ED visits per year overall and by MDC and primary ICD-9-CM diagnosis.Results:Adjusted mean PFR for 2012 admissions, including preceding ED visits, was 1.264 (95% CI, 1.264, 1.265) for commercially insured admissions (n=2,614,326) and 1.177 (1.176, 1.177) for Medicaid admissions (n=816,503), indicating professional payments increased total per-admission payments by an average 26.4% and 17.7%, respectively, above facility-only payments. Adjusted mean PFR for 2012 ED visits was 1.286 (1.286, 1.286) for commercially insured visits (n=8,808,734) and 1.440 (1.439, 1.440) for Medicaid visits (n=2,994,696). Supplemental tables report 2004-2012 annual PFR estimates by clinical classifications.Conclusions:Adjustments for professional fees are recommended when hospital facility-only financial data from US hospital discharge datasets are used to estimate health care costs.