Why is use of the Medicare Intensive Behavioral Therapy for Obesity Benefit so low? Finding what works to promote wider dissemination.

为什么 Medicare 肥胖强化行为疗法福利的使用率如此之低？

• 批准号: 9216914
• 负责人: JODI Summers HOLTROP
• 金额: $ 36.63万
• 依托单位: UNIVERSITY OF COLORADO DENVER
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-09-30 至 2019-09-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9216914
• 关键词: Why; use; Medicare; Intensive; Behavioral

Obesity is one of the most prevalent and challenging public health issues of our time. In November 2011, the Centers for Medicare and Medicaid Services (CMS) approved the use of a new Healthcare Common Procedure Coding System (HCPCS) code for payment in primary care for providing Intensive Behavioral Therapy (IBT) treatment for obese patients. Despite the widespread prevalence of obesity in the Medicare population, use of this benefit has been substantially lower than expected suggesting significant underutilization of this benefit. This exploratory study will pursue the following aims: 1) To develop a thorough understanding of the most pressing issues related to the use and non-use of the Medicare IBT for obesity benefit in primary care, and 2) To study the strategies used in practices that have successfully implemented services in accordance with the IBT for obesity Medicare benefit and describe: a) characteristics of these practices and their environmental context, b) key elements of the implementation process that facilitate successful in-practice intervention, c) patients use of the IBT for obesity benefit, including continuing receipt of services after meeting the weight loss requirement of the benefit, and d) cost to provide the service relative to the reimbursement amount. To accomplish aim 1, we will query the Medicare Provider Utilization and Payment Data: Physician and Other Supplier database for three states: Colorado, Michigan, and North Carolina and identify all providers and their practices that have been paid by Medicare for delivering IBT for obesity services to 10 or more beneficiaries in a year between 2012 and 2014. We will identify the primary care practices of these providers and conduct semi-structured telephone interviews with the universe of practices (up to 100 total). We will then identify practices that are not using the IBT benefit, matched on zip code, practice size (>5 providers), and family or internal medicine to practices using the benefit and conduct similar interviews with this group. Interviews will assess practice characteristics, reasons for use, non-use and stopping use of the benefit, processes and personnel involved, and any known patient results. To accomplish aim 2, we will purposefully select 36 practices from aim 1 that meet our criteria for IBT for obesity implementation success to collect in- depth information to understand their implementation, patient outcomes and costs. Data gathering will include on-site interviews and observations, and EMR data extraction. Normalization process theory will be used to understand factors important to implementation. These methods will also be used to obtain information to estimate the cost to the practice of providing IBT services and assess its sustainability under current and alternative reimbursement amounts. Our findings have direct policy implications informing the dissemination and sustainability of effective implementation strategies that can be learned from practices continuing to deliver IBT for obesity services. This study will add to the field by determining the use of this benefit, reasons for use and discontinuation of use, and identify potential strategies for effective implementation of IBT in primary care.

肥胖是当今时代最普遍和最具挑战性的公共卫生问题之一。 2011 年 11 月， 医疗保险和医疗补助服务中心 (CMS) 批准使用新的医疗保健共同点 用于提供强化行为治疗的初级保健付款的程序编码系统 (HCPCS) 代码 肥胖患者的治疗（IBT）治疗。尽管肥胖在医疗保险中普遍存在 人口中，这项福利的使用率大大低于预期，这表明 这一好处没有得到充分利用。本探索性研究将追求以下目标： 1) 制定全面的 了解与使用和不使用 Medicare IBT 治疗肥胖相关的最紧迫问题 初级保健的益处，以及 2) 研究已成功实施的实践中使用的策略 根据肥胖医疗保险福利 IBT 提供的服务并描述： a) 这些服务的特点 实践及其环境背景，b) 促进实施过程的关键要素 成功的实践干预，c) 患者使用 IBT 来获得肥胖益处，包括持续接受 满足福利减重要求后的服务，以及 d) 提供服务的相关成本 报销金额。为了实现目标 1，我们将查询医疗保险提供者的使用情况和付款情况 数据：三个州的医生和其他供应商数据库：科罗拉多州、密歇根州和北卡罗来纳州 确定所有由 Medicare 支付为肥胖症提供 IBT 服务的提供者及其做法 2012 年至 2014 年间，每年向 10 名或更多受益人提供援助。我们将确定 这些提供商并对实践领域进行半结构化电话访谈（最多 100 全部的）。然后，我们将确定未使用 IBT 福利的诊所，并与邮政编码、诊所规模（>5 提供者）以及家庭或内科医生使用该福利的实践，并与此进行类似的访谈 团体。访谈将评估实践特征、使用、不使用和停止使用该福利的原因， 涉及的流程和人员，以及任何已知的患者结果。为了实现目标2，我们将有目的地 从目标 1 中选择 36 种符合我们肥胖实施 IBT 成功标准的做法，以收集- 深度信息以了解其实施情况、患者结果和成本。数据收集将包括 现场访谈和观察，以及EMR数据提取。标准化过程理论将用于 了解对实施重要的因素。这些方法也将用于获取信息 估计提供 IBT 服务的实践成本并评估其在当前和 替代补偿金额。我们的研究结果对传播具有直接的政策影响 以及可以从持续交付的实践中学到的有效实施战略的可持续性 肥胖服务 IBT。这项研究将通过确定这种好处的使用、使用原因来补充该领域 和停止使用，并确定在初级保健中有效实施 IBT 的潜在策略。