Biological Sciences Division, Pritzker School of Medicine, University of Chicago, Chicago, Illinois.
Division of General Internal Medicine and Geriatrics, Oregon Health & Science University, Portland.
JAMA Netw Open. 2022 Aug 1;5(8):e2229504. doi: 10.1001/jamanetworkopen.2022.29504.
Time-based billing options for physicians have expanded, enabling many physicians to bill according to time spent instead of medical decision-making (MDM) level for fee-for-service outpatient visits. However, no study to date has estimated the revenue changes associated with time-based billing.
To compare evaluation and management (E/M) reimbursement for physicians using time-based billing vs MDM-based billing for outpatient visits of varying lengths.
DESIGN, SETTING, AND PARTICIPANTS: This economic evaluation used 2019 billing data for outpatient E/M codes and 2021 reimbursement rates from the Centers for Medicare & Medicaid Services. Modeling of generic clinic templates was performed to estimate expected yearly E/M revenues for a single full-time physician working in an outpatient clinic using fee-for-service billing.
Yearly E/M revenues for different patient visit templates were modeled. The standardized length of return patient visits was 10 to 45 minutes, and new patient visits were twice as long in duration.
Under MDM-based billing, increased visit length was associated with decreased E/M revenue ($564 188 for 30-minute new patient visit/15-minute return patient visit vs $423 137 for 40-minute new patient visit/20-minute return patient visit). Under time-based billing, yearly E/M revenue remained similar across increasing visit lengths ($400 432 for 30-minute new patient visit/15-minute return patient visit vs $458 718 for 40-minute new patient visit/20-minute return patient visit). Compared with time-based billing, MDM-based billing was associated with higher E/M revenue for 10- to 15-minute return patient visits ($400 432 vs $564 188). Time-based billing was associated with higher E/M revenue for return patient visits lasting 20 minutes or longer. The highest modeled E/M revenue of $846 273 occurred for 10-minute return patient visits under MDM-based billing.
Results of this study showed that the relative economic benefits of MDM-based billing and time-based billing differed and were associated with the length of patient visits. Physicians with longer patient visits were more likely to experience revenue increases from using time-based billing than physicians with shorter patient visits.
医生的基于时间的计费选项已经扩大，使许多医生能够根据服务时间而不是医疗决策（MDM）水平为门诊就诊计费。 然而，迄今为止尚无研究估计与基于时间的计费相关的收入变化。
比较基于时间的计费与基于 MDM 的计费在不同时间长度的门诊就诊时的医师评估和管理（E/M）报销。
设计、地点和参与者： 这项经济评估使用了 2019 年门诊 E/M 代码的计费数据和 2021 年医疗保险和医疗补助服务中心的报销率。对通用诊所模板进行建模，以估算在使用按服务计费的情况下，在门诊诊所全职工作的单个医生的预期年度 E/M 收入。
为不同的患者就诊模板建模了年度 E/M 收入。复诊患者的标准化就诊时间为 10 至 45 分钟，新患者的就诊时间则延长一倍。
在基于 MDM 的计费下，就诊时间的延长与 E/M 收入的减少相关（30 分钟的新患者就诊/15 分钟复诊与 40 分钟的新患者就诊/20 分钟复诊相比，收入减少 564188 美元）。在基于时间的计费下，随着就诊时间的增加，年度 E/M 收入保持相似（30 分钟的新患者就诊/15 分钟复诊与 40 分钟的新患者就诊/20 分钟复诊相比，收入为 400432 美元）。与基于时间的计费相比，基于 MDM 的计费与 10 至 15 分钟复诊患者的 E/M 收入较高（400432 美元对 564188 美元）。基于时间的计费与 20 分钟或更长时间的复诊患者的 E/M 收入较高。在基于 MDM 的计费下，最高的 E/M 收入为 846273 美元，发生在 10 分钟复诊患者身上。
这项研究的结果表明，基于 MDM 的计费和基于时间的计费的相对经济优势不同，并且与就诊时间的长短有关。就诊时间较长的医生比就诊时间较短的医生更有可能从基于时间的计费中获得收入增长。
