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首页> 外文期刊>Trends in Ecology & Evolution >Differences in the Complexity of Office Visits by Physician Specialty: NAMCS 2013-2016
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Differences in the Complexity of Office Visits by Physician Specialty: NAMCS 2013-2016

机译：医师专业办公室访问复杂性的差异：NAMCS 2013-2016

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Background Specialty-to-specialty variation in use of outpatient evaluation and management service codes could lead to important differences in reimbursement among specialties. Objective To compare the complexity of visits to physicians whose incomes are largely dependent on evaluation and management services to the complexity of visits to physicians whose incomes are largely dependent on procedures. Design, Setting, and Participants We analyzed 53,670 established patient outpatient visits reported by physicians in the National Ambulatory Medical Care Survey (NAMCS) from 2013 to 2016. We defined high complexity visits as those with an above average number of diagnoses (> 2) and/or medications (> 3) listed We based our comparison on time intervals corresponding to typical outpatient evaluation and management times as defined by the Current Procedural Terminology Manual and specialty utilization of evaluation and management codes based on 2015 Medicare payments. Main Outcome and Measures Proportion of complex visits by specialty category. Key Results We found significant differences in the content of similar-length office visits provided by different specialties. For level 4 established outpatient visits (99214), the percentage involving high diagnostic complexity ranged from 62% for internal medicine, 52% for family medicine/general practice, and 41% for neurology (specialties whose incomes are largely dependent on evaluation and management codes), to 34% for dermatology, 42% for ophthalmology, and 25% for orthopedic surgery (specialties whose incomes are more dependent on procedure codes) (pvalue of the difference < 0.001). High medication complexity was found in the following proportions of visits: internal medicine 56%, family medicine/general practice 49%, and neurology 43%, as compared with dermatology 33%, ophthalmology 30%, and orthopedic surgery 30% (pvalue of the difference < 0.001). Conclusion Within the same duration visits, specialties whose incomes depend more on evaluation and management codes on average addressed more clinical issues and managed more medications than specialties whose incomes are more dependent on procedures.
机译：背景技术门诊评估和管理服务代码的使用专业变化可能导致专业中报销的重要差异。目的比较对Incomes在很大程度上取决于评估和管理服务的影响，对其收入在很大程度上依赖程序的医生的复杂性的复杂性。我们在2013年至2016年度分析了医生报告的53,670名既定患者门诊访问，从2013年至2016年分析了医生报告的/或药物（> 3）列出了我们基于对应于当前程序术语手册和基于2015 Medicare支付的评估和管理代码专业利用所定义的典型门诊评估和管理时间的时间间隔的比较。主要结果，采取专业类别复杂访问的比例。关键结果我们发现不同专业提供的类似长度办公室访问内容的显着差异。对于第4级成立的门诊访问（99214），涉及高诊断复杂性的百分比范围为内科62％，家庭医学/一般实践的52％，神经内科的41％（其收入在很大程度上取决于评估和管理代码） ），皮肤科的34％，眼科42％，骨科手术的25％（其收入更依赖于程序代码）（差异<0.001）。在以下比例的访问中发现了高药物复杂性：内科56％，家庭医学/一般练习49％，而神经内容43％，与皮肤病学相比33％，眼科30％和整形外科30％（pvalue）差异<0.001）。结论在相同的持续时间内，收入更多地依赖于评估和管理代码的特色，平均涉及更多临床问题，并使更多的药物管理多，其收入更依赖程序。

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