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Effects of removing a fee-for-service incentive on specialist chronic disease services: a time-series analysis
Andrew Appleton1,2, Melody Lam2, Britney Le2
1Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
Insights
Removing a fee-for-service premium reduced chronic disease follow-up visits but not total follow-up care. This suggests changes in billing rather than actual service reduction, warranting further study on patient outcomes.
Area of Science:
- Health Services Research
- Medical Economics
- Clinical Practice Management
Background:
- Physician payment models significantly influence healthcare service delivery and volume.
- Financial incentives, like fee-for-service premiums, can shape specialist practice patterns.
- Understanding these effects is crucial for optimizing healthcare resource allocation.
Purpose of the Study:
- To evaluate the impact of removing a fee-for-service premium on chronic disease follow-up services.
- To assess changes in service provision among internal medicine, cardiology, nephrology, and gastroenterology specialists.
- To compare these changes with specialists who retained eligibility for the premium.
Main Methods:
- Utilized linked administrative health care data from Ontario, Canada (April 2013–March 2017).
- Conducted a time-series analysis comparing service provision before and after premium removal (April 1, 2015).
- Analyzed monthly visits for chronic disease follow-up, total follow-up, and new patient consultations.
Main Results:
- A significant decrease in monthly chronic disease follow-up visits was observed post-premium removal.
- No significant change in total follow-up visits or the comparison group was noted.
- A significant downward trend in new patient consultations occurred in the affected specialist groups.
Conclusions:
- The reduction in chronic disease follow-up visits is likely attributable to altered diagnostic coding rather than a decrease in actual patient care.
- Further research is needed to determine the implications of these findings on patient health outcomes.
- Physician payment reform requires careful consideration of potential unintended consequences on service delivery.
Introduction:
Physician payment models are known to affect the nature and volume of services provided. Our objective was to study the effects of removing a financial incentive, the fee-for-service premium, on the provision of chronic disease follow-up services by internal medicine, cardiology, nephrology and gastroenterology specialists.
Methods:
We collected linked administrative health care data for the period 1 April 2013 to 31 March 2017 from databases held at the Institute for Clinical Evaluative Sciences (ICES) in Ontario, Canada. We conducted a time-series analysis before and after the removal of the fee-for-service premium on 1 April 2015. The primary outcome was total monthly visits for chronic disease follow-up services. Secondary outcomes were monthly visits for total follow-up services and new patient consultations. We compared internal medicine, cardiology, nephrology and gastroenterology specialists practising during the study timeframe with respirology, hematology, endocrinology, rheumatology and infectious diseases specialists who remained eligible to claim the premium. We chose this comparison group as these are all subspecialties of internal medicine, providing similar services.
Results:
The number of chronic disease follow-up visits decreased significantly after removal of the premium, but there was no decrease in total follow-up visits. There was also a significant downward trend in new patient consultations. No changes were observed in the comparison group.
Conclusion:
The decrease in volume of chronic disease follow-up visits can be explained by diagnostic criteria being met less often, rather than an actual reduction in services provided. Potential effects on patient outcomes require further exploration.
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