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.
Below: Schutte Scale for rating the perceived quality of care
A high perceived quality of care rating was observed on interpersonal relations, conditions of the examination rooms and nursing care services with an overall mean score of 9/10. Self-introduction by the health worker, explanation of examination procedures, consent seeking, encouragement to ask questions, confidentiality protection and being offered to have a guardian during delivery were associated with a high quality rating of interpersonal relations for antenatal and delivery care services. Being literate, never experienced a still birth and, first ANC visit were associated with a high quality rating of room conditions for antenatal care service.
The study highlights some of the multiple factors associated with perceived quality of care. We conclude that proper interventions or practices and policies should consider these factors when making quality improvements.
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