背景:戒烟仍然是医疗保健领域的关键挑战,由于经济激励措施不一致和培训不足,基于证据的干预措施往往未得到充分利用。这项研究旨在量化医疗保健系统中错过戒烟机会的经济影响,从而评估潜在的收入损失,并评估基于系统的方法来加强戒烟工作的有效性。
方法:一项回顾性队列研究利用了来自宾夕法尼亚州和马里兰州的8家医院区域卫生系统的汇总的去识别患者健康数据,从1/1/21到12/31/23。分析的重点是符合戒烟咨询条件的初级保健(CPT代码99406或99407),潜在收入是根据医疗保险报销率计算的。
结果:超过三年,和507,656次办公室访问,与使用烟草的人接触的人中只有1,557(0.3%)被收取戒烟服务费用。如果每个被确定为使用烟草的人都被持续收取戒烟咨询费用,则估计获得的总潜在收入为每年5,947,018.13美元和1,982,339.38美元。
结论:这项研究揭示了戒烟服务的潜在收费和实际收费之间的巨大差距,不仅强调了错失机会的财务影响,而且还验证了卫生系统对公共卫生的影响。费用不足导致每年可观的收入损失,并破坏了针对烟草相关疾病的初级预防工作。调查结果阐明了加强计费实践和系统性变化的必要性,包括影响适当计费的政策改进,以通过改进戒烟干预措施来促进公共卫生利益。
BACKGROUND: Tobacco cessation remains a critical challenge in healthcare, with evidence-based interventions often under-utilized due to misaligned economic incentives and inadequate training. This study aims to quantify the economic impact of missed billing opportunities for tobacco cessation in a healthcare system, thereby assessing potential revenue loss and evaluating the effectiveness of systems-based approaches to enhancing tobacco cessation efforts.
METHODS: A retrospective cohort study utilized aggregated de-identified patient health data from an 8-hospital regional health system across Pennsylvania and Maryland, from 1/1/21 to 12/31/23. The analysis focused on primary care encounters eligible for tobacco cessation counseling (CPT codes 99406 or 99407), with potential revenue calculated based on the Medicare reimbursement rate.
RESULTS: Over three years, and 507,656 office visits, only 1,557 (0.3%) of encounters with persons using tobacco were billed for cessation services. The estimated total potential revenue gained if each person who was identified as using tobacco was billed consistently for tobacco cessation counseling was $5,947,018.13, and $1,982,339.38 annually.
CONCLUSIONS: The study reveals a significant gap between the potential and actual billing for tobacco cessation services, highlighting not only the financial implications of missed opportunities but also a validation of a health system\'s public health impact. Underbilling contributes to considerable annual revenue loss and undermines primary prevention efforts against tobacco-related diseases. The findings illuminate the need for enhanced billing practices and systemic changes, including policy improvements that influence proper billing to promote public health benefits through improved tobacco cessation interventions.