医疗保险的护理管理代码可能无法如预期那样支持初级护理。
Medicare's Care Management Codes Might Not Support Primary Care As Expected.
作者信息
Agarwal Sumit D, Barnett Michael L, Souza Jeffrey, Landon Bruce E
机构信息
Sumit D. Agarwal ( sagarwal14@bwh. harvard. edu ) is a primary care physician at Brigham and Women's Hospital, in Boston, Massachusetts, and a PhD candidate in health policy at Harvard University, in Cambridge, Massachusetts.
Michael L. Barnett is an assistant professor of health policy and management in the Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, in Boston, and a primary care physician at Brigham and Women's Hospital.
出版信息
Health Aff (Millwood). 2020 May;39(5):828-836. doi: 10.1377/hlthaff.2019.00329.
To enhance compensation for primary care activities that occur outside of face-to-face visits, the Centers for Medicare and Medicaid Services recently introduced new billing codes for transitional care management (TCM) and chronic care management (CCM) services. Overall, rates of adoption of these codes have been low. To understand the patterns of adoption, we compared characteristics of the practices that billed for these services to those of the practices that did not and determined the extent to which a practice other than the beneficiary's usual primary care practice billed for the services. Larger practices and those using other novel billing codes were more likely to adopt TCM or CCM. Over a fifth of all TCM claims and nearly a quarter of all CCM claims were billed by a practice that was not the beneficiary's assigned primary care practice. Our results raise concerns about whether these codes are supporting primary care as originally expected.
为提高对面对面就诊之外的初级保健活动的补偿，医疗保险和医疗补助服务中心最近引入了过渡性护理管理（TCM）和慢性护理管理（CCM）服务的新计费代码。总体而言，这些代码的采用率一直很低。为了解采用模式，我们将开具这些服务账单的医疗机构的特征与未开具账单的医疗机构的特征进行了比较，并确定了除受益人的常规初级保健机构之外的其他机构为这些服务开具账单的程度。规模较大的机构以及使用其他新型计费代码的机构更有可能采用TCM或CCM。超过五分之一的TCM索赔和近四分之一的CCM索赔是由并非受益人的指定初级保健机构开具账单的。我们的结果引发了对于这些代码是否如最初预期那样支持初级保健的担忧。
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