| Evidence-based imaging guidelines and Medicare payment policy. | |
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MedLine Citation:
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PMID: 18454778 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVE: This study examines the relationship between evidence-based appropriateness criteria for neurologic imaging procedures and Medicare payment determinations. The primary research question is whether Medicare is more likely to pay for imaging procedures as the level of appropriateness increases. DATA SOURCES: The American College of Radiology Appropriateness Criteria (ACRAC) for neurological imaging, ICD-9-CM codes, CPT codes, and payment determinations by the Medicare Part B carrier for Florida and Connecticut. STUDY DESIGN: Cross-sectional study of appropriateness criteria and Medicare Part B payment policy for neurological imaging. In addition to descriptive and bivariate statistics, multivariate logistic regression on payment determination (yes or no) was performed. DATA COLLECTION METHODS: The American College of Radiology Appropriateness Criteria (ACRAC) documents specific to neurological imaging, ICD-9-CM codes, and CPT codes were used to create 2,510 medical condition/imaging procedure combinations, with associated appropriateness scores (coded as low/middle/high). PRINCIPAL FINDINGS: As the level of appropriateness increased, more medical condition/imaging procedure combinations were payable (low = 61 percent, middle = 70 percent, and high = 74 percent). Logistic regression indicated that the odds of a medical condition/imaging procedure combination with a middle level of appropriateness being payable was 48 percent higher than for an otherwise similar combination with a low appropriateness score (95 percent CI on odds ratio=1.19-1.84). The odds ratio for being payable between high and low levels of appropriateness was 2.25 (95 percent CI: 1.66-3.04). CONCLUSIONS: Medicare could improve its payment determinations by taking advantage of existing clinical guidelines, appropriateness criteria, and other authoritative resources for evidence-based practice. Such an approach would give providers a financial incentive that is aligned with best-practice medicine. In particular, Medicare should review and update its payment policies to reflect current information on the appropriateness of alternative imaging procedures for the same medical condition. |
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Authors:
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Christopher L Sistrom; Niccie L McKay |
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Publication Detail:
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Type: Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't |
Journal Detail:
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Title: Health services research Volume: 43 ISSN: 0017-9124 ISO Abbreviation: Health Serv Res Publication Date: 2008 Jun |
Date Detail:
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Created Date: 2008-05-05 Completed Date: 2008-07-01 Revised Date: 2010-09-21 |
Medline Journal Info:
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Nlm Unique ID: 0053006 Medline TA: Health Serv Res Country: United States |
Other Details:
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Languages: eng Pagination: 1006-24 Citation Subset: IM |
Affiliation:
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Department of Radiology, University of Florida School of Medicine, PO Box 100374, Gainesville, FL 32610-0374, USA. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Connecticut Cross-Sectional Studies Current Procedural Terminology Diagnostic Imaging / economics* Evidence-Based Medicine* Florida Guidelines as Topic Humans Insurance Coverage International Classification of Diseases Medicare Part B / economics*, organization & administration Nervous System Diseases / pathology, radiography, radionuclide imaging Organizational Policy* Radiology Department, Hospital / economics* Reimbursement Mechanisms / organization & administration* United States |
| Grant Support | |
ID/Acronym/Agency:
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K30 HL004109/HL/NHLBI NIH HHS |
| Comments/Corrections | |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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