Weeks William B, Whedon James M, Toler Andrew, Goertz Christine M
Professor, The Departments of Psychiatry and of Community and Family Medicine, Geisel School of Medicine, The Dartmouth Institute for Health Policy and Clinical Research, Lebanon, NH.
J Manipulative Physiol Ther. 2013 Oct;36(8):468-81. doi: 10.1016/j.jmpt.2013.07.003. Epub 2013 Aug 28.
The purposes of this study were to examine the direct costs associated with Medicare's 2005-2007 "Demonstration of Expanded Coverage of Chiropractic Services" (Demonstration) and their drivers, to explore practice pattern variation during the Demonstration, and to describe scenarios of cost implications had provider behavior and benefit coverage been different.
Using Medicare Part B data from April 1, 2005, and March 31, 2007, and 2004 Rural Urban Continuum Codes, we conducted a retrospective analysis of traditionally reimbursed and expanded chiropractic services provided to patients aged 65 to 99 years who had a neuromusculoskeletal condition. We compared chiropractic care costs, supply, and utilization patterns for the 2-year periods before, during, and after the Demonstration for 5 Chicago area counties that participated in the Demonstration to those for 6 other county aggregations-urban or rural counties that participated in the Demonstration; were designated comparison counties during the Demonstration; or were neither participating nor comparison counties during the Demonstration.
When compared with other groups, doctors of chiropractic in 1 region (Chicago area counties) billed more aggressively for expanded services and were reimbursed significantly more for traditionally reimbursed chiropractic services provided before, during, and after the Demonstration. Costs would have been substantially lower had doctors of chiropractic in this 1 region had responded similarly to those in other demonstration counties.
We found widespread geographic variation in practice behavior and patterns. Our findings suggest that Medicare might reduce the risk of accelerated costs associated with the introduction of a new benefit by applying appropriate limits to the frequency of use and overall costs of those benefits, particularly in highly competitive markets.
本研究旨在考察与医疗保险2005 - 2007年“脊椎按摩疗法服务扩大覆盖范围示范项目”（示范项目）相关的直接成本及其驱动因素，探究示范项目期间的执业模式差异，并描述若提供者行为和福利覆盖范围不同时成本影响的情景。
利用2005年4月1日至2007年3月31日的医疗保险B部分数据以及2004年城乡连续体代码，我们对向患有神经肌肉骨骼疾病的65至99岁患者提供的传统报销和扩大后的脊椎按摩疗法服务进行了回顾性分析。我们将参与示范项目的芝加哥地区5个县在示范项目前、期间和之后的2年期间的脊椎按摩疗法护理成本、供应和使用模式，与其他6个县集合体（参与示范项目的城市或农村县；在示范项目期间被指定为对照县；或在示范项目期间既未参与也不是对照县）的模式进行了比较。
与其他组相比，1个地区（芝加哥地区各县）的脊椎按摩疗法医生对扩大服务的计费更为积极，并且在示范项目前、期间和之后提供的传统报销脊椎按摩疗法服务获得的报销显著更多。如果该1个地区的脊椎按摩疗法医生的反应与其他示范县的医生相似，成本将会大幅降低。
我们发现执业行为和模式存在广泛的地域差异。我们的研究结果表明，医疗保险可能通过对这些福利的使用频率和总体成本施加适当限制来降低与引入新福利相关的成本加速风险，特别是在竞争激烈的市场中。
