Physician Perception of Reimbursement for Outpatient Procedures Among Managed Care Patients With Diabetes Mellitus
Department of Medicine, Division of General Internal Medicine, University of Michigan, Ann Arbor, MI 48109-0429, USA. The American journal of managed care
(Impact Factor: 2.26).
To examine the association between physicians' reimbursement perceptions and outpatient test performance among patients with diabetes mellitus.
Participants were physicians (n = 766) and their managed care patients with diabetes mellitus (n = 2758) enrolled in 6 plans in 2003. Procedures measured included electrocardiography, radiography or x-ray films, urine microalbumin levels, glycosylated hemoglobin levels, and Pap smears for women. Hierarchical logistic regression models were adjusted for health plan and physician-level clustering and for physician and patient covariates. To minimize confounding by unmeasured health plan variables, we adjusted for health plan as a fixed effect. Therefore, we estimated variation between physicians using only the variance within health plans.
Patients of physicians who reported reimbursement for electrocardiography were more likely to undergo electrocardiography than patients of physicians who did not perceive reimbursement (unadjusted mean difference, 4.9%; 95% confidence interval, 1.1%-8.9%; and adjusted mean difference, 3.9%; 95% confidence interval, 0.2%-7.8%). For the other tests examined, no significant differences in procedure performance were found between patients of physicians who perceived reimbursement and patients of physicians who did not perceive reimbursement.
Reimbursement perception was associated with electrocardiography but not with other commonly performed outpatient procedures. Future research should investigate how associations change with perceived amount of reimbursement and their interactions with other influences on test-ordering behavior such as perceived appropriateness.
Available from: Marcis Leja
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ABSTRACT: A number of recent guidelines have discouraged the use of the old anti-gliadin tests for the detection of celiac disease; tissue transglutaminase IgA (tTGA) and anti-endomysial (EMA) tests are recommended instead. Our aim was to evaluate how the current recommendations have been applied in real practice. The secondary aim was to evaluate the positivity rates provided by different test types.
We analyzed the number of celiac disease tests [anti-gliadin IgA (AGA), anti-gliadin IgG (AGG), tTGA and EMA] performed by the largest laboratory in Latvia. The analysis was performed on a yearly basis for the period between 2004 and 2009. Additionally, we analyzed the percentage of the positive test results for each of the tests.
The number of patients being tested for celiac disease constantly increased, with the average annual growth of 16.1%; this trend was similar both in children and in adults. The majority of patients (62.6%) were tested with anti-gliadin tests only; 27.7% were tested with either tTGA or EMA, while 9.7% were tested by a combination of the above groups. There was a substantial difference in the positivity rates of the different tests from 0.94% for EMA to 21.8% for AGG. Substantial differences were also present between various manufacturers' products.
The current guidelines and the published evidence on the proper use of serological tests for celiac disease have been slow to be applied in clinical practice; more intensive education campaigns and change in reimbursement systems could improve the situation. Nevertheless, more clinicians in Latvia are checking patients for celiac disease; this suggests an overall increased awareness.
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