Dataset Information

Pediatric primary care psychologists' reported level of integration, billing practices, and reimbursement frequency.

ABSTRACT: INTRODUCTION:Integration of psychological services into pediatric primary care is increasingly common, but models of integration vary with regard to their level of coordination, colocation, and integration. High-integration models may provide some distinct advantages, such as preventative care and brief consultation for subclinical behavior concerns; however, psychologists face barriers to seeking reimbursement for these services. Alternatives to traditional psychotherapy and psychological testing codes, specifically Health & Behavior (H&B) codes, have been proposed as 1 method for supporting integrated care. The aim of this study was to investigate the relationships between psychologists' reported billing practices, reimbursement rates, and model of integration in pediatric primary care. METHOD:As part of a larger survey study, 55 psychologists working in pediatric primary care reported on characteristics of their practice's model of integration, billing practices, and frequency of reimbursement for consultative services. RESULTS:Compared with those who categorized their integrated care model as colocated, psychologists who endorsed working in integrated models reported a significantly higher usage of H&B codes and more frequent reimbursement for consultations. Overall, use of H&B codes was associated with higher reported levels of coordination and integration. DISCUSSION:Survey results showed a clear pattern of higher integration being associated with greater utilization of H&B codes and better reimbursement for consultation activities. These results underscore the importance of establishing and maintaining billing and reimbursement systems that adequately support integrated care. (PsycINFO Database Record

SUBMITTER: Riley AR

PROVIDER: S-EPMC5880712 | biostudies-literature | 2018 Mar

REPOSITORIES: biostudies-literature

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Pediatric primary care psychologists' reported level of integration, billing practices, and reimbursement frequency.

Riley Andrew R AR Grennan Allison A Menousek Kathryn K Hoffses Kathryn W KW

Families, systems & health : the journal of collaborative family healthcare 20171127 1

<h4>Introduction</h4>Integration of psychological services into pediatric primary care is increasingly common, but models of integration vary with regard to their level of coordination, colocation, and integration. High-integration models may provide some distinct advantages, such as preventative care and brief consultation for subclinical behavior concerns; however, psychologists face barriers to seeking reimbursement for these services. Alternatives to traditional psychotherapy and psychologic ...[more]

PMID: 29172627

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Project description:Introduction: Publications arguing against the null hypothesis significance testing (NHST) procedure and in favor of good statistical practices have increased. The most frequently mentioned alternatives to NHST are effect size statistics (ES), confidence intervals (CIs), and meta-analyses. A recent survey conducted in Spain found that academic psychologists have poor knowledge about effect size statistics, confidence intervals, and graphic displays for meta-analyses, which might lead to a misinterpretation of the results. In addition, it also found that, although the use of ES is becoming generalized, the same thing is not true for CIs. Finally, academics with greater knowledge about ES statistics presented a profile closer to good statistical practice and research design. Our main purpose was to analyze the extension of these results to a different geographical area through a replication study. Methods: For this purpose, we elaborated an on-line survey that included the same items as the original research, and we asked academic psychologists to indicate their level of knowledge about ES, their CIs, and meta-analyses, and how they use them. The sample consisted of 159 Italian academic psychologists (54.09% women, mean age of 47.65 years). The mean number of years in the position of professor was 12.90 (SD = 10.21). Results: As in the original research, the results showed that, although the use of effect size estimates is becoming generalized, an under-reporting of CIs for ES persists. The most frequent ES statistics mentioned were Cohen's d and R2/?2, which can have outliers or show non-normality or violate statistical assumptions. In addition, academics showed poor knowledge about meta-analytic displays (e.g., forest plot and funnel plot) and quality checklists for studies. Finally, academics with higher-level knowledge about ES statistics seem to have a profile closer to good statistical practices. Conclusions: Changing statistical practice is not easy.This change requires statistical training programs for academics, both graduate and undergraduate.

Project description:Community-acquired pneumonia (CAP) remains one of the most common indications for pediatric hospitalization in the United States, and it is frequently the focus of research and quality studies. Use of administrative data is increasingly common for these purposes, although proper validation is required to ensure valid study conclusions.To validate administrative billing data for hospitalizations owing to childhood CAP.Case-control study of 4 tertiary care, freestanding children’s hospitals in the United States.A total of 998 medical records of a 25% random sample of 3646 children discharged in 2010 with at least 1 International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) code representing possible pneumonia were reviewed. Discharges (matched on date of admission) without a pneumonia-related discharge code were also examined to identify potential missed pneumonia cases. Two reference standards, based on provider diagnosis alone (provider confirmed) or in combination with consistent clinical and radiographic evidence of pneumonia (definite), were used to identify CAP.Twelve ICD-9-CM–based coding strategies, each using a combination of primary or secondary codes representing pneumonia or pneumonia-related complications. Six algorithms excluded children with complex chronic conditions.Sensitivity, specificity, and negative and positive predictive values (NPV and PPV, respectively) of the 12 identification strategies.For provider-confirmed CAP (n?=?680), sensitivity ranged from 60.7% to 99.7%; specificity, 75.7% to 96.4%; PPV, 67.9% to 89.6%; and NPV, 82.6% to 99.8%. For definite CAP (n?=?547), sensitivity ranged from 65.6% to 99.6%; specificity, 68.7% to 93.0%; PPV, 54.6% to 77.9%; and NPV, 87.8% to 99.8%. Unrestricted use of the pneumonia-related codes was inaccurate, although several strategies improved specificity to more than 90% with a variable effect on sensitivity. Excluding children with complex chronic conditions demonstrated the most favorable performance characteristics. Performance of the algorithms was similar across institutions.Administrative data are valuable for studying pediatric CAP hospitalizations. The strategies presented here will aid in the accurate identification of relevant and comparable patient populations for research and performance improvement studies.

Project description:BACKGROUND:Financial concerns are often cited by physicians as a barrier to administering routinely recommended vaccines to adults. The purpose of this study was to assess perceived payments and profit from administering recommended adult vaccines and vaccine purchasing practices among general internal medicine (GIM) and family medicine (FM) practices in the United States. METHODS:We conducted an interviewer-administered survey from January-June 2014 of practices stratified by specialty (FM or GIM), affiliation (standalone or???2 practice sites), and level of financial decision-making (independent or larger system level) in FM and GIM practices that responded to a previous survey on adult vaccine financing and provided contact information for follow-up. Practice personnel identified as knowledgeable about vaccine financing and billing responded to questions about payments relative to vaccine purchase price and payment for vaccine administration, perceived profit on vaccination, claim denial, and utilization of various purchasing strategies for private vaccine stocks. Survey items on payment and perceived profit were assessed for various public and private payer types. Descriptive statistics were calculated and responses compared by physician specialty, practice affiliation, and level of financial decision-making. RESULTS:Of 242 practices approached, 43% (n?=?104) completed the survey. Reported payment levels and perceived profit varied by payer type. Only for preferred provider organizations did a plurality of respondents report profiting on adult vaccination services. Over half of respondents reported losing money vaccinating adult Medicaid beneficiaries. One-quarter to one-third of respondents reported not knowing about Medicare Part D payment levels for vaccine purchase and vaccine administration, respectively. Few respondents reported negotiating with manufacturers or insurance plans on vaccine purchase prices or payments for vaccination. CONCLUSIONS:Practices vaccinating adults may benefit from education and technical assistance related to vaccine financing and billing and greater use of purchasing strategies to decrease upfront vaccine cost.

Dataset Information

Pediatric primary care psychologists' reported level of integration, billing practices, and reimbursement frequency.

Publications

Pediatric primary care psychologists' reported level of integration, billing practices, and reimbursement frequency.

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