评估和管理支付政策变化与医疗保险支付专业医生
Hannah T Neprash1, Ezra Golberstein1, Ishani Ganguli2,3
1University of Minnesota, School of Public Health, Minneapolis.
2021年的医疗保险支付变化略有减少了初级保健医生和专家之间的收入差距. 虽然初级保健支付增加了,但支付差距的总体减少是有限的,需要进一步研究.
科学领域:
- 健康经济学
- 医疗政策
- 医生补贴
背景情况:
- 美国初级保健医生 (PCP) 在历史上收入低于专家,导致劳动力短缺.
- 医疗保险和医疗补助服务中心 (CMS) 在2021年更新了评估和管理 (E/M) 服务支付和文档.
- 这些政策变化旨在缩小初级保健和专科医生的薪酬差异.
研究的目的:
- 模拟2021年E/M支付政策调整对医疗保险医生总支付的影响,保持患者数量不变.
- 将模拟的支付变化与医疗保险总支付和EM编码强度的观察变化进行比较.
- 在政策实施之前和之后分析初级保健和专家之间的支付差距.
主要方法:
- 追溯观察性研究分析了美国医疗机构的医生,医疗保险费用很高 (≥5000名医生,≥50次服务费访问).
- 通过使用2021年E/M支付费率重新定价2020年医疗保险支付.
- 2020年7月至12月和2021年7月至12月期间的EM访问强度 (4-5级) 和医疗保险总支付的比较.
主要成果:
- 家庭医生中位数 (11.0%) 增加,但放射科医生中位数下降 (-3.3%).
- 大多数专业,特别是精神病学 (17.8个百分点) 中,高强度EM访问的中位数上升.
- 初级保健医生和专家医生之间的支付差距减少了2.0% (825.1美元),从40,259.8美元降至39,434.7美元.
结论:
- 2021年E/M支付政策变化影响了跨专业的医疗保险支付.
- 主治医生和专家之间的薪酬差距只有很小.
- 这些发现可能受到COVID-19大流行的影响;建议进行进一步的研究.
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