Advanced

Increased registration of hypertension and cancer diagnoses after the introduction of a new reimbursement system

Hjerpe, Per LU ; Bostrom, Kristina Bengtsson; Lindblad, Ulf and Merlo, Juan LU (2012) In Scandinavian Journal of Primary Health Care 30(4). p.222-228
Abstract
Objective. To investigate the impact on ICD coding behaviour of a new case-mix reimbursement system based on coded patient diagnoses. The main hypothesis was that after the introduction of the new system the coding of chronic diseases like hypertension and cancer would increase and the variance in propensity for coding would decrease on both physician and health care centre (HCC) levels. Design. Cross-sectional multilevel logistic regression analyses were performed in periods covering the time before and after the introduction of the new reimbursement system. Setting. Skaraborg primary care, Sweden. Subjects. All patients (n = 76 546 to 79 826) 50 years of age and older visiting 468 to 627 physicians at the 22 public HCCs in five... (More)
Objective. To investigate the impact on ICD coding behaviour of a new case-mix reimbursement system based on coded patient diagnoses. The main hypothesis was that after the introduction of the new system the coding of chronic diseases like hypertension and cancer would increase and the variance in propensity for coding would decrease on both physician and health care centre (HCC) levels. Design. Cross-sectional multilevel logistic regression analyses were performed in periods covering the time before and after the introduction of the new reimbursement system. Setting. Skaraborg primary care, Sweden. Subjects. All patients (n = 76 546 to 79 826) 50 years of age and older visiting 468 to 627 physicians at the 22 public HCCs in five consecutive time periods of one year each. Main outcome measures. Registered codes for hypertension and cancer diseases in Skaraborg primary care database (SPCD). Results. After the introduction of the new reimbursement system the adjusted prevalence of hypertension and cancer in SPCD increased from 17.4% to 32.2% and from 0.79% to 2.32%, respectively, probably partly due to an increased diagnosis coding of indirect patient contacts. The total variance in the propensity for coding declined simultaneously at the physician level for both diagnosis groups. Conclusions. Changes in the healthcare reimbursement system may directly influence the contents of a research database that retrieves data from clinical practice. This should be taken into account when using such a database for research purposes, and the data should be validated for each diagnosis. (Less)
Please use this url to cite or link to this publication:
author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Electronic health records, general practice, ICD codes, incentive, multilevel analysis, primary health care, reimbursement, Sweden
in
Scandinavian Journal of Primary Health Care
volume
30
issue
4
pages
222 - 228
publisher
Taylor & Francis
external identifiers
  • wos:000311550200005
  • scopus:84870159314
ISSN
0281-3432
DOI
10.3109/02813432.2012.735552
language
English
LU publication?
yes
id
de27fe13-fdbf-49cb-ad0c-acac52ed5656 (old id 3379537)
date added to LUP
2013-02-01 07:03:06
date last changed
2017-09-24 03:20:49
@article{de27fe13-fdbf-49cb-ad0c-acac52ed5656,
  abstract     = {Objective. To investigate the impact on ICD coding behaviour of a new case-mix reimbursement system based on coded patient diagnoses. The main hypothesis was that after the introduction of the new system the coding of chronic diseases like hypertension and cancer would increase and the variance in propensity for coding would decrease on both physician and health care centre (HCC) levels. Design. Cross-sectional multilevel logistic regression analyses were performed in periods covering the time before and after the introduction of the new reimbursement system. Setting. Skaraborg primary care, Sweden. Subjects. All patients (n = 76 546 to 79 826) 50 years of age and older visiting 468 to 627 physicians at the 22 public HCCs in five consecutive time periods of one year each. Main outcome measures. Registered codes for hypertension and cancer diseases in Skaraborg primary care database (SPCD). Results. After the introduction of the new reimbursement system the adjusted prevalence of hypertension and cancer in SPCD increased from 17.4% to 32.2% and from 0.79% to 2.32%, respectively, probably partly due to an increased diagnosis coding of indirect patient contacts. The total variance in the propensity for coding declined simultaneously at the physician level for both diagnosis groups. Conclusions. Changes in the healthcare reimbursement system may directly influence the contents of a research database that retrieves data from clinical practice. This should be taken into account when using such a database for research purposes, and the data should be validated for each diagnosis.},
  author       = {Hjerpe, Per and Bostrom, Kristina Bengtsson and Lindblad, Ulf and Merlo, Juan},
  issn         = {0281-3432},
  keyword      = {Electronic health records,general practice,ICD codes,incentive,multilevel analysis,primary health care,reimbursement,Sweden},
  language     = {eng},
  number       = {4},
  pages        = {222--228},
  publisher    = {Taylor & Francis},
  series       = {Scandinavian Journal of Primary Health Care},
  title        = {Increased registration of hypertension and cancer diagnoses after the introduction of a new reimbursement system},
  url          = {http://dx.doi.org/10.3109/02813432.2012.735552},
  volume       = {30},
  year         = {2012},
}