Stirring the pot: Switching from blended fee‐for‐service to blended capitation models of physician remuneration

Objective To compare differences in clinical activity and remuneration between male and female rheumatologists and to evaluate associations between physician gender and practice sizes and patient volume, accounting for rheumatologists’ age, and calendar year effects. Methods We conducted a population-based study in Ontario, Canada between 2000-2015 identifying all rheumatologists practicing as full-time equivalents (FTE) or above and assessed differences in practice sizes (number of unique patients), practice volumes (number of patient visits), and remuneration (total fee-for-service billings) between male and female rheumatologists. Multivariable linear regression was used to evaluate the effects of gender on practice size and volume separately, accounting for age and year. Results The number of rheumatologists practicing at or above one FTE increased from 89 to 120 from 2000 to 2015, with the percentage of females increasing from 27.0% to 41.7%. Males had larger practice sizes and practice volumes. Remuneration was consistently higher for males (between $46,000-$102,000 annually). Our adjusted analyses estimated that in a given year, males saw a mean of 606 (95% CI 107-1105) more patients than females did, and had 1,059 (95% CI 345- 1773) more patient visits. Among males and females combined, there was a small but statistically significant reduction in mean annual number of patient visits, and middle-aged rheumatologists had greater practice sizes and volumes than their younger/older counterparts. Conclusion On average, female rheumatologists saw fewer patients and had fewer patient visits annually relative to males, resulting in lower earnings. Increasing feminization necessitates workforce planning to ensure that populations’ needs are met.

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Evaluating the Completness of Physician Billing Claims: A Proof-of-Concept Study

International Journal for Population Data Science ◽

10.23889/ijpds.v1i1.205 ◽

2017 ◽

Vol 1 (1) ◽

Author(s):

Lisa Lix ◽

John Paul Kuwornu ◽

George Kephart ◽

Khokan Sikdar ◽

Mark Smith ◽

...

Keyword(s):

Claims Data ◽

Linear Trend ◽

Prescription Medication ◽

P Value ◽

Fee For Service ◽

Proof Of Concept ◽

Observation Window ◽

Physician Billing ◽

Physician Remuneration ◽

The Impact

ABSTRACTObjectivesAn increasing number of physicians are remunerated by alternative forms of payment, instead of conventional fee-for-service (FFS) payments. Changes in physician remuneration methods can to influence the completeness of physician billing claims databases, because physicians on alternative payments may not consistently complete billing records. However, there is no established technique to estimate the magnitude of data loss. This proof-of-concept study estimated completeness of physician claims by comparing them with prescription drug records. We applied the method to estimate completeness of non-fee-for-service (NFFS) and FFS physician claims data over time in Manitoba, Canada. ApproachOur method uses information on the date of patient initiation of a new prescription medication, payment method of the prescribing physician, and presence/absence of a physician billing claim prior to the medication initiation date. A billing claim within 7 days of the medication initiation date was defined as a captured claim; if there was no claim in this observation window, it was classified as missed. Our method was applied to annual patient cohorts who initiated a common prescription medication (i.e., anti-hypertensives) between fiscal years 1998/99 and 2012/13. A sensitivity analysis used a 21-day observation window to identify captured/missing claims. Multivariable hierarchical logistic regression models tested patient and prescriber characteristics associated with missing claims. ResultsThe cohort consisted of 274, 462 individuals with a new anti-hypertensive prescription medication. A total of 9.2% of the cohort had a NFFS prescribing physician in 1998/99; this increased to 20.2% in 2012/13 (linear trend p-value < .0001). The percentage of NFFS prescribers almost doubled, from 10.0% to 17.8%. The percentage of the annual cohorts with a FFS prescribing physician and a missing claim remained close to 13.0%. However, the percentage of the annual cohorts with a NFFS prescribing physician and a missing claim increased from 15.6% to 23.3% (linear trend p-value < .0001), and was always higher than the FFS percentage. Patient age, sex, and comorbidity and physician specialty and practice location were associated with the odds of a missing claim. ConclusionThe percentage of missing claims was higher for patients with NFFS than FFS prescribing physicians, demonstrating the impact of physician remuneration on database completeness. The trend of greater data loss in later than earlier years suggests that completeness of physician billing claims data may be decreasing. Our method can be applied across jurisdictions to compare the impact of physician payment methods on data quality.

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Physician remuneration schemes, psychiatric hospitalizations and follow-up care: Evidence from blended fee-for-service and capitation models

Social Science & Medicine ◽

10.1016/j.socscimed.2020.113465 ◽

2021 ◽

Vol 268 ◽

pp. 113465

Author(s):

Thyna Vu ◽

Kelly K. Anderson ◽

Rose Anne Devlin ◽

Nibene H. Somé ◽

Sisira Sarma

Keyword(s):

Fee For Service ◽

Psychiatric Hospitalizations ◽

Follow Up Care ◽

Physician Remuneration

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Physician Remuneration: Fee-for-service Must Go, But Then What?

Restructuring Canada's Health Systems: How Do We Get There From Here? ◽

10.3138/9781442653672-007 ◽

1992 ◽

Author(s):

Charles J. Wright

Keyword(s):

Fee For Service ◽

Physician Remuneration

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Features of physician services databases in Canada

Chronic Diseases and Injuries in Canada ◽

10.24095/hpcdp.32.4.02 ◽

2012 ◽

Vol 32 (4) ◽

pp. 186-193 ◽

Cited By ~ 6

Author(s):

L.M. Lix ◽

R. Walker ◽

H. Quan ◽

R. Nesdole ◽

J. Yang ◽

...

Keyword(s):

Primary Source ◽

Fee For Service ◽

Hospital Services ◽

Physician Services ◽

Provider Characteristics ◽

Coding Systems ◽

Canadian Institute ◽

Canadian Studies ◽

Physician Remuneration ◽

Data Elements

Introduction Physician services databases (PSDs) are a valuable resource for research and surveillance in Canada. However, because the provinces and territories collect and maintain separate databases, data elements are not standardized. This study compared major features of PSDs. Methods The primary source was a survey of key informants that collected information about years of data, patient/provider characteristics, database inclusions/exclusions, coding of diagnoses, procedures and service locations. Data from the Canadian Institute for Health Information's (CIHI) National Physician Database were used to examine physician remuneration methods, which may affect PSD completeness. Survey data were obtained for nine provinces and two territories. Results Most databases contained post-1990 records. Diagnoses were frequently recorded using ICD-9 codes. Other coding systems differed across jurisdictions and time, although all PSDs identified in-hospital services and distinguished family medicine from other specialties. Capture of non-fee-for-service records varied and CIHI data revealed an increasing proportion of non-fee-for-service physicians over time. Conclusion Further research is needed to investigate the potential effects of PSD differences on comparability of findings from pan-Canadian studies.

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