評価と管理の支払い政策の変更 専門医によるメディケア支払い
Hannah T Neprash1, Ezra Golberstein1, Ishani Ganguli2,3
1University of Minnesota, School of Public Health, Minneapolis.
JAMA
|February 28, 2023
まとめ
2021年のメディケア給付の変更により,プライマリケア医師と専門医の所得格差がわずかに減りました. プライマリケアでは支払いが増加したが,支払いのギャップの全体的な削減は限られており,さらなる研究が必要であった.
科学分野:
- 健康経済学
- 医療政策
- 医療費の補償
背景:
- アメリカのプライマリケア医 (PCP) は歴史的に専門医より少ない収入を得ており,労働力不足に寄与しています.
- メディケア・メディケイド・サービスセンター (CMS) は,2021年に評価・管理 (E/M) サービスの支払いとドキュメントを更新しました.
- これらの政策変更は,プライマリケアと専門医の間の支払い格差を縮小することを目的としています.
研究 の 目的:
- 2021年のE/M支払い政策の調整が,患者数を一定に保って,メディケアの医師の支払い総額に与える影響をシミュレートする.
- シミュレートされた支払いの変化と,Medicareの支払いの総額と,E/Mのコード化強度の観測された変化を比較する.
- 政策の実施前と後のプライマリケアと専門医の賃金格差の変化を分析する.
主な方法:
- メディケアの請求額が大きい米国の診療所の医師を分析した遡及的観察研究 (≥5000人の医師,≥50人の診療費用).
- 2021年のE/M支払い率を使用して2020年のサービスを再定価化することで,シミュレートされたメディケア支払いをします.
- E/M訪問の強度 (レベル4〜5) と2020年7月から2021年12月までのメディケア支払いの合計を比較した.
主要な成果:
- シミュレートされたボリュームコンスタントの支払いは,家庭医の平均値 (11. 0%) で増加したが,放射線科医の平均値 (- 3. 3%) で減少した.
- E/M訪問の平均比率は,ほとんどの専門分野,特に精神医学 (17.8パーセントポイント) で増加しました.
- 初等医療と専門医の支払いの差は2.0% (825.1ドル) 減少し,40,259.8ドルから39,434.7ドルとなった.
結論:
- 2021年のE/M支払い方針の変更は,専門分野におけるメディケア支払いに影響を及ぼしました.
- 主治医と専門医の給料の格差はわずかに縮まった.
- 発見はCOVID-19のパンデミックの影響を受ける可能性があります.さらなる研究が推奨されています.
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