Implications of Changes in Medicare Payment and Documentation for Primary Care Spending and Time Use.
Implications of Changes in Medicare Payment and Documentation for Primary Care Spending and Time Use.
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医疗保险付款和初级保健支出和时间使用文件的变化的影响。
DOI：
10.1007/s11606-020-05857-4
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发表时间：
2021
影响因子：
5.7
通讯作者：
Landon,BruceE
中科院分区：
文献类型：
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作者：
Basu,Sanjay;Song,Zirui;Phillips,RussellS;Bitton,Asaf;Landon,BruceE
METHODS我们使用了一个先前验证的模型，4它模拟了全国人口的初级保健提供者和他们的病人，反映了目前的模式的利用，支出和实践水平的收入和成本从所有付款人。初级保健支出被定义为全科、全科内科或家庭医生的所有付款之和，包括按就诊代码划分的特定地区医疗保险付款（数据来自N= 181，664名初级保健提供者，表1）。5根据先前的实践时间使用研究6估计了减少的文件时间，并将其分解为访视期间、访视以外的实践时间和实践时间之后的时间（表1）。为了估计潜在的所有付款人的影响，我们重新计算了结果，如果商业保险公司和医疗补助计划采用与医疗保险计划相同的比例增加费率和文件规则。我们还确定了潜在的访问编码的影响，以更高的复杂性水平，减少了文件的要求。
METHODSWe used a previously-validated model, 4 which simulates the national population of primary care providers and their patients, reflecting current patterns of utilization, spending, and practice-level revenues and costs from all payers. Primary care spending was defined as the sum of all payments to practitioners in general practice, general internal medicine, or family practice, and included geography-specific Medicare payments by visit code (data from N= 181,664 primary care providers, Table 1). 5 Reduced documentation time was estimated based on a prior practice time use study, 6 and disaggregated into time spent during visits, outside of visits during practice hours, and after practice hours (Table 1). To estimate potential all-payer effects, we re-calculated the outcomes if commercial insurers and Medicaid adopted the same proportionate rate increase and documentation rules as Medicare. We also identified the implications of potential up-coding of visits to higher levels of complexity given the reduced documentation requirements.