Hrdy S A, Hoppe P M, Bouda D W
Blue Cross and Blue Shield of Nebraska.
Nebr Med J. 1993 Sep;78(9):299-305.
Blue Cross and Blue Shield of Nebraska physician claims data were used to generate and test the hypothesis that there are major differences in psychiatrist practice patterns between the Omaha and Lincoln areas, as evidenced by billing practices. There were extreme differences between the population-based claim rates for the Omaha and Lincoln areas which led to the hypotheses stated above. Provider-based methodology was used to demonstrate that, for Nebraska psychiatrists, as patient load increases, number of charges per patient decreases. Psychiatrists with large market shares for the two respective areas were compared also. Fifty percent of the Omaha psychiatrists with large market shares had a significantly high number of claims per patient, whereas only 25% of the Lincoln psychiatrists (with large market shares) had significantly high numbers of claims per patient. Our hypothesis that there are major differences between Omaha and Lincoln psychiatrist practice patterns was supported. Recommendations include follow-up with the "Patient Satisfaction Survey", continued monitoring, and investigation by the medical community to determine causes for the wide discrepancies in psychiatrist practice patterns.
内布拉斯加州蓝十字蓝盾保险公司的医生索赔数据被用于生成和检验一个假设，即奥马哈和林肯地区精神科医生的执业模式存在重大差异，这一点从计费方式上可以得到证明。奥马哈和林肯地区基于人群的索赔率存在极大差异，这导致了上述假设的提出。基于提供者的方法被用来证明，对于内布拉斯加州的精神科医生来说，随着患者负荷的增加，每位患者的收费次数会减少。还比较了两个地区拥有较大市场份额的精神科医生。奥马哈地区50%拥有较大市场份额的精神科医生每位患者的索赔数量显著较高，而林肯地区（拥有较大市场份额）只有25%的精神科医生每位患者的索赔数量显著较高。我们关于奥马哈和林肯精神科医生执业模式存在重大差异的假设得到了支持。建议包括跟进“患者满意度调查”、持续监测，以及由医学界进行调查，以确定精神科医生执业模式存在巨大差异的原因。
