Getting What You Pay For: The Economics of Quality Care for Sexually Transmitted Infections
BACKGROUND:
Understanding
the relationship between charges, reimbursement, and quality for sexually
transmitted infection (STI) care is necessary to evaluate consequences of
shifting patients from STI specialty to nonspecialty settings and to inform
quality improvement efforts in this area.
METHODS:
Chart
reviews were used to evaluate quality of documented STI care among 450 patients
across 5 different clinical settings within a large safety net hospital in
Massachusetts for patients presenting with penile discharge/dysuria or vaginal
discharge. Charges billed and recouped by the hospital for each visit were
extracted from billing records. Univariate methods examined unadjusted
differences between quality and other patient and practice characteristics, and
charges billed and recouped, whereas a multivariable model predicted the effect
of quality on charges and reimbursements after adjusting for potential
confounders.
RESULTS:
Higher
documented quality of care was associated with higher charges, with each
additional quality point predicting a 9% increase in visit charges. However,
these charges were not recouped by the institution, as quality was not
associated with higher levels of hospital reimbursement. Among sites of care,
the STI clinic had the highest average quality score, as well as the lowest
average amount billed and recouped.
CONCLUSIONS:
The
relationship we find between documented quality and charges billed may reflect
resource use for patient visits. The hospital, however, did not recoup any more
on average from higher-quality visits, thus posing an incentive problem for the
institution. Our findings suggest that loss of government funds for STI clinics
may not be replaced by hospital billing and may lead to lower quality of care.
- 1From the *Boston University School of Public Health, Boston, MA; †Boston University School of Medicine, Boston, MA; ‡Center for Healthcare Organization and Implementation Research, ENRM VA Hospital, Bedford, MA; §Massachusetts Department of Public Health, Boston, MA.
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