Gidengil Courtney A, Mehrotra Ateev, Kranz Ashley M, Butcher Emily, Hilborne Lee H, Wynn Barbara O
Rand Health Q. 2017 Jan 1;7(1):3. eCollection 2017 Jan.
The Centers for Medicare & Medicaid Services (CMS) uses the resource-based relative value system to determine payment for physicians and nonphysician practitioners for their professional services. For many surgeries and other types of procedures, Medicare payment includes pre- and post-operative visits delivered during a global period of 10 or 90 days. Congress mandated that CMS collect data on the "number and level" of visits in the global period from a representative sample of physicians beginning January 1, 2017. At CMS's request, RAND developed a new set of nonpayment codes that could be used to capture the number and level of visits. In July 2016, CMS issued a proposed rule that included a slightly modified version of the codes developed by RAND and proposed to require their use by practitioners. Given that these codes had never been tested or used by practitioners, CMS asked RAND to pilot the proposed codes to determine whether practitioners understood and could accurately apply the codes. RAND's approach was to create a series of vignettes and to test the use of these vignettes using semi-structured interviews with a small set of physicians, followed by more-extensive testing through surveys with a larger group of physicians. This study provides recommendations on how to use vignettes to test new codes and uncover questions about such codes. Such input could be used to help refine instructions for using codes, as well as to potentially refine the codes themselves.
医疗保险和医疗补助服务中心（CMS）使用基于资源的相对价值系统来确定医生和非医生从业者提供专业服务的报酬。对于许多手术和其他类型的医疗程序，医疗保险支付包括在10天或90天的全球期内进行的术前和术后问诊。国会要求CMS从2017年1月1日起，从具有代表性的医生样本中收集全球期内问诊的“数量和级别”数据。应CMS的要求，兰德公司开发了一套新的非支付代码，可用于记录问诊的数量和级别。2016年7月，CMS发布了一项拟议规则，其中包括兰德公司开发的代码的略微修改版本，并提议要求从业者使用这些代码。鉴于这些代码从未经过从业者测试或使用，CMS要求兰德公司对拟议代码进行试点，以确定从业者是否理解并能准确应用这些代码。兰德公司的方法是创建一系列案例，并通过对一小部分医生进行半结构化访谈来测试这些案例的使用情况，随后通过对更多医生进行调查进行更广泛的测试。本研究就如何使用案例来测试新代码以及发现有关此类代码的问题提供了建议。这些意见可用于帮助完善代码使用说明，以及可能对代码本身进行完善。
