Radiology Solutions, Philips Healthcare, 3000 Minuteman Road, Andover, MA 01810, USA.
Enterprise Information Technology Department, Lahey Health, 41 Burlington Mall Road, Burlington, MA 01805, USA.
Int J Med Inform. 2017 Dec;108:71-77. doi: 10.1016/j.ijmedinf.2017.09.012. Epub 2017 Sep 28.
Across the United States, there is a growing number of patients in Accountable Care Organizations and under risk contracts with commercial insurance. This is due to proliferation of new value-based payment models and care delivery reform efforts. In this context, the business model of radiology within a hospital or health system context is shifting from a primary profit-center to a cost-center with a goal of cost savings. Radiology departments need to increasingly understand how the transactional nature of the business relates to financial rewards. The main challenge with current reporting systems is that the information is presented only at an aggregated level, and often not broken down further, for instance, by type of exam. As such, the primary objective of this research is to provide better visibility into payments associated with individual radiology procedures in order to better calibrate expense/capital structure of the imaging enterprise to the actual revenue or value-add to the organization it belongs to.
We propose a methodology that can be used to determine technical payments at a procedure level. We use a proportion based model to allocate payments to individual radiology procedures based on total charges (which also includes non-radiology related charges).
Using a production dataset containing 424,250 radiology exams we calculated the overall average technical charge for Radiology to be $873.08 per procedure and the corresponding average payment to be $326.43 (range: $48.27 for XR and $2750.11 for PET/CT) resulting in an average payment percentage of 37.39% across all exams.
We describe how charges associated with a procedure can be used to approximate technical payments at a more granular level with a focus on Radiology. The methodology is generalizable to approximate payment for other services as well. Understanding payments associated with each procedure can be useful during strategic practice planning.
Charge-to-total charge ratio can be used to approximate radiology payments at a procedure level.
在美国，越来越多的患者在问责制医疗组织（Accountable Care Organizations，ACOs）和商业保险的风险合同下接受治疗。这是由于新的基于价值的支付模式和医疗服务改革努力的普及。在这种情况下，医院或医疗系统内放射科的商业模式正在从主要的利润中心转变为成本中心，目标是节约成本。放射科部门需要越来越了解业务的交易性质与财务回报之间的关系。当前报告系统的主要挑战是，信息仅以汇总的形式呈现，而且通常没有进一步细分，例如，没有按检查类型进行细分。因此，本研究的主要目标是提供更好地了解与个别放射科程序相关的支付情况，以便更好地调整成像企业的费用/资本结构，使其与所属组织的实际收入或附加值相匹配。
我们提出了一种可以用于确定程序层面技术支付的方法。我们使用基于比例的模型，根据总费用（包括与放射科无关的费用）将支付分配给个别放射科程序。
使用包含 424250 次放射科检查的生产数据集，我们计算出放射科的总体平均技术费用为每个程序 873.08 美元，相应的平均支付为每个程序 326.43 美元（范围：XR 为 48.27 美元，PET/CT 为 2750.11 美元），导致所有检查的平均支付百分比为 37.39%。
我们描述了如何使用与程序相关的费用来更精细地估算技术支付，重点是放射科。该方法也可推广到其他服务的支付估算。了解每个程序的支付情况，在策略性的实践规划中会很有用。
费用与总费用的比率可用于估算程序层面的放射科支付。
