Changes in screening colonoscopy following Medicare reimbursement and cost‐sharing changes

Objectives To compare existing algorithms for classifying screening vs diagnostic colonoscopies and to quantify the increase in screening colonoscopy rates when Medicare began reimbursement in 2001 and when the Affordable Care Act (ACA) eliminated cost‐sharing. Data Sources Twenty percent random sam...

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Published inHealth services research Vol. 54; no. 4; pp. 839 - 850
Main Authors Song, Lina D., Newhouse, Joseph P., Garcia‐De‐Albeniz, Xabier, Hsu, John
Format Journal Article
LanguageEnglish
Published United States Health Research and Educational Trust 01.08.2019
Blackwell Publishing Ltd
John Wiley and Sons Inc
Subjects
Affordable Care Act
Aged
algorithm
Algorithms
Changes
claims data
Classification
Colon
Colonoscopy
Colonoscopy - economics
Colonoscopy - statistics & numerical data
Colorectal Neoplasms - diagnosis
Cost analysis
Cost sharing
Cost Sharing - economics
Cost Sharing - statistics & numerical data
Diagnostic systems
Early Detection of Cancer - economics
Early Detection of Cancer - statistics & numerical data
Economic aspects
False Positive Reactions
Female
Government programs
Government regulation
Health Policy and Organizational Behavior
Humans
Insurance, Health, Reimbursement
Interpretation and construction
Laws, regulations and rules
Legal fees
Male
Medical economics
Medical law
Medical screening
Medicare
Patient Protection and Affordable Care Act - legislation & jurisprudence
Reimbursement
screening colonoscopy
Sensitivity
United States
United States
Affordable Care Act
screening colonoscopy
cost-sharing
algorithm
claims data
Online AccessGet full text
ISSN0017-9124
1475-6773
1475-6773
DOI10.1111/1475-6773.13150

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Abstract Objectives To compare existing algorithms for classifying screening vs diagnostic colonoscopies and to quantify the increase in screening colonoscopy rates when Medicare began reimbursement in 2001 and when the Affordable Care Act (ACA) eliminated cost‐sharing. Data Sources Twenty percent random sample of fee‐for‐service (FFS) Medicare claims, 2000‐2012. Study Design Using recent administrative codes as tarnished gold standards, we examined the sensitivity and specificity of five published algorithms for classifying colonoscopies and calculated annual screening colonoscopy rates. We estimated the change in rates after Medicare began reimbursement and used difference‐in‐differences analysis to estimate the effects of eliminating cost‐sharing by comparing states with and without a mandate to cover screening colonoscopy prior to the ACA. Findings Model‐based algorithms have higher sensitivity (0.53‐0.99) than expert‐based algorithms (0.35‐0.39), but lower specificity (0.43‐0.65 vs 0.79‐0.88). All algorithms detected increases in screening from both Medicare's reimbursement change (range: 24‐93/10 000) and the 2011 cost‐sharing change (range: 1.1‐34/10 000). Difference‐in‐difference estimates of the ACA's effect varied from 51 to 155 tests per 10 000 depending on the algorithm. Conclusions Screening colonoscopy rates increased after eliminating cost‐sharing in 2011, but the increase's size varied depending on the algorithm used to classify the indication. Improvements are needed in Medicare coding for screening.
AbstractList Objectives: To compare existing algorithms for classifying screening vs diagnostic colonoscopies and to quantify the increase in screening colonoscopy rates when Medicare began reimbursement in 2001 and when the Affordable Care Act (ACA) eliminated cost-sharing. Data Sources: Twenty percent random sample of fee-for-service (FFS) Medicare claims, 2000-2012. Study Design: Using recent administrative codes as tarnished gold standards, we examined the sensitivity and specificity of five published algorithms for classifying colonoscopies and calculated annual screening colonoscopy rates. We estimated the change in rates after Medicare began reimbursement and used difference-indifferences analysis to estimate the effects of eliminating cost-sharing by comparing states with and without a mandate to cover screening colonoscopy prior to the ACA. Findings: Model-based algorithms have higher sensitivity (0.53-0.99) than expert-based algorithms (0.35-0.39), but lower specificity (0.43-0.65 vs 0.79-0.88). All algorithms detected increases in screening from both Medicare's reimbursement change (range: 24-93/10 000) and the 2011 cost-sharing change (range: 1.1-34/10 000). Difference-in-difference estimates of the ACA's effect varied from 51 to 155 tests per 10 000 depending on the algorithm. Conclusions: Screening colonoscopy rates increased after eliminating cost-sharing in 2011, but the increase's size varied depending on the algorithm used to classify the indication. Improvements are needed in Medicare coding for screening. KEYWORDS Affordable Care Act, algorithm, claims data, cost-sharing, screening colonoscopy
Objectives To compare existing algorithms for classifying screening vs diagnostic colonoscopies and to quantify the increase in screening colonoscopy rates when Medicare began reimbursement in 2001 and when the Affordable Care Act (ACA) eliminated cost‐sharing. Data Sources Twenty percent random sample of fee‐for‐service (FFS) Medicare claims, 2000‐2012. Study Design Using recent administrative codes as tarnished gold standards, we examined the sensitivity and specificity of five published algorithms for classifying colonoscopies and calculated annual screening colonoscopy rates. We estimated the change in rates after Medicare began reimbursement and used difference‐in‐differences analysis to estimate the effects of eliminating cost‐sharing by comparing states with and without a mandate to cover screening colonoscopy prior to the ACA. Findings Model‐based algorithms have higher sensitivity (0.53‐0.99) than expert‐based algorithms (0.35‐0.39), but lower specificity (0.43‐0.65 vs 0.79‐0.88). All algorithms detected increases in screening from both Medicare's reimbursement change (range: 24‐93/10 000) and the 2011 cost‐sharing change (range: 1.1‐34/10 000). Difference‐in‐difference estimates of the ACA's effect varied from 51 to 155 tests per 10 000 depending on the algorithm. Conclusions Screening colonoscopy rates increased after eliminating cost‐sharing in 2011, but the increase's size varied depending on the algorithm used to classify the indication. Improvements are needed in Medicare coding for screening.
ObjectivesTo compare existing algorithms for classifying screening vs diagnostic colonoscopies and to quantify the increase in screening colonoscopy rates when Medicare began reimbursement in 2001 and when the Affordable Care Act (ACA) eliminated cost‐sharing.Data SourcesTwenty percent random sample of fee‐for‐service (FFS) Medicare claims, 2000‐2012.Study DesignUsing recent administrative codes as tarnished gold standards, we examined the sensitivity and specificity of five published algorithms for classifying colonoscopies and calculated annual screening colonoscopy rates. We estimated the change in rates after Medicare began reimbursement and used difference‐in‐differences analysis to estimate the effects of eliminating cost‐sharing by comparing states with and without a mandate to cover screening colonoscopy prior to the ACA.FindingsModel‐based algorithms have higher sensitivity (0.53‐0.99) than expert‐based algorithms (0.35‐0.39), but lower specificity (0.43‐0.65 vs 0.79‐0.88). All algorithms detected increases in screening from both Medicare's reimbursement change (range: 24‐93/10 000) and the 2011 cost‐sharing change (range: 1.1‐34/10 000). Difference‐in‐difference estimates of the ACA's effect varied from 51 to 155 tests per 10 000 depending on the algorithm.ConclusionsScreening colonoscopy rates increased after eliminating cost‐sharing in 2011, but the increase's size varied depending on the algorithm used to classify the indication. Improvements are needed in Medicare coding for screening.
To compare existing algorithms for classifying screening vs diagnostic colonoscopies and to quantify the increase in screening colonoscopy rates when Medicare began reimbursement in 2001 and when the Affordable Care Act (ACA) eliminated cost-sharing. Twenty percent random sample of fee-for-service (FFS) Medicare claims, 2000-2012. Using recent administrative codes as tarnished gold standards, we examined the sensitivity and specificity of five published algorithms for classifying colonoscopies and calculated annual screening colonoscopy rates. We estimated the change in rates after Medicare began reimbursement and used difference-in-differences analysis to estimate the effects of eliminating cost-sharing by comparing states with and without a mandate to cover screening colonoscopy prior to the ACA. Model-based algorithms have higher sensitivity (0.53-0.99) than expert-based algorithms (0.35-0.39), but lower specificity (0.43-0.65 vs 0.79-0.88). All algorithms detected increases in screening from both Medicare's reimbursement change (range: 24-93/10 000) and the 2011 cost-sharing change (range: 1.1-34/10 000). Difference-in-difference estimates of the ACA's effect varied from 51 to 155 tests per 10 000 depending on the algorithm. Screening colonoscopy rates increased after eliminating cost-sharing in 2011, but the increase's size varied depending on the algorithm used to classify the indication. Improvements are needed in Medicare coding for screening.
To compare existing algorithms for classifying screening vs diagnostic colonoscopies and to quantify the increase in screening colonoscopy rates when Medicare began reimbursement in 2001 and when the Affordable Care Act (ACA) eliminated cost-sharing.OBJECTIVESTo compare existing algorithms for classifying screening vs diagnostic colonoscopies and to quantify the increase in screening colonoscopy rates when Medicare began reimbursement in 2001 and when the Affordable Care Act (ACA) eliminated cost-sharing.Twenty percent random sample of fee-for-service (FFS) Medicare claims, 2000-2012.DATA SOURCESTwenty percent random sample of fee-for-service (FFS) Medicare claims, 2000-2012.Using recent administrative codes as tarnished gold standards, we examined the sensitivity and specificity of five published algorithms for classifying colonoscopies and calculated annual screening colonoscopy rates. We estimated the change in rates after Medicare began reimbursement and used difference-in-differences analysis to estimate the effects of eliminating cost-sharing by comparing states with and without a mandate to cover screening colonoscopy prior to the ACA.STUDY DESIGNUsing recent administrative codes as tarnished gold standards, we examined the sensitivity and specificity of five published algorithms for classifying colonoscopies and calculated annual screening colonoscopy rates. We estimated the change in rates after Medicare began reimbursement and used difference-in-differences analysis to estimate the effects of eliminating cost-sharing by comparing states with and without a mandate to cover screening colonoscopy prior to the ACA.Model-based algorithms have higher sensitivity (0.53-0.99) than expert-based algorithms (0.35-0.39), but lower specificity (0.43-0.65 vs 0.79-0.88). All algorithms detected increases in screening from both Medicare's reimbursement change (range: 24-93/10 000) and the 2011 cost-sharing change (range: 1.1-34/10 000). Difference-in-difference estimates of the ACA's effect varied from 51 to 155 tests per 10 000 depending on the algorithm.FINDINGSModel-based algorithms have higher sensitivity (0.53-0.99) than expert-based algorithms (0.35-0.39), but lower specificity (0.43-0.65 vs 0.79-0.88). All algorithms detected increases in screening from both Medicare's reimbursement change (range: 24-93/10 000) and the 2011 cost-sharing change (range: 1.1-34/10 000). Difference-in-difference estimates of the ACA's effect varied from 51 to 155 tests per 10 000 depending on the algorithm.Screening colonoscopy rates increased after eliminating cost-sharing in 2011, but the increase's size varied depending on the algorithm used to classify the indication. Improvements are needed in Medicare coding for screening.CONCLUSIONSScreening colonoscopy rates increased after eliminating cost-sharing in 2011, but the increase's size varied depending on the algorithm used to classify the indication. Improvements are needed in Medicare coding for screening.
Audience Trade
Author Newhouse, Joseph P.
Hsu, John
Song, Lina D.
Garcia‐De‐Albeniz, Xabier
AuthorAffiliation 3 Department of Health Care Policy Harvard Medical School Boston Massachusetts
6 Faculty of Arts and Sciences Harvard University Cambridge Massachusetts
1 PhD Program in Health Policy The Graduate School of Arts and Sciences Harvard University Cambridge Massachusetts
4 Department of Health Policy and Management Harvard T.H. Chan School of Public Health Boston Massachusetts
7 Department of Epidemiology Harvard T.H. Chan School of Public Health Boston Massachusetts
2 Health Policy Research Center Mongan Institute, Massachusetts General Hospital Boston Massachusetts
5 The John F. Kennedy School of Government Harvard University Cambridge Massachusetts
AuthorAffiliation_xml – name: 1 PhD Program in Health Policy The Graduate School of Arts and Sciences Harvard University Cambridge Massachusetts
– name: 7 Department of Epidemiology Harvard T.H. Chan School of Public Health Boston Massachusetts
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– name: 4 Department of Health Policy and Management Harvard T.H. Chan School of Public Health Boston Massachusetts
– name: 6 Faculty of Arts and Sciences Harvard University Cambridge Massachusetts
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  givenname: Lina D.
  orcidid: 0000-0003-0971-8054
  surname: Song
  fullname: Song, Lina D.
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  organization: Mongan Institute, Massachusetts General Hospital
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  givenname: Joseph P.
  surname: Newhouse
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  organization: Harvard University
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  givenname: John
  surname: Hsu
  fullname: Hsu, John
  organization: Harvard Medical School
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Keywords Affordable Care Act
screening colonoscopy
cost-sharing
algorithm
claims data
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2010; 59
2015; 3
2012
2016; 108
2017; 67
2015; 121
2008; 17
2011; 11
2006; 296
2008; 35
2008; 149
2009; 150
2004; 2
2011; 171
2005; 2005
2004; 291
2013; 11
2017; 36
2015; 81
2015; 313
2013; 32
2013; 13
2010; 29
2017; 17
2002; 40
2006; 25
2014; 14
2015
2012; 26
2008; 134
2008; 112
2014; 52
2004; 119
2014; 12
2016; 25
2014; 104
2006; 166
2009; 18
1998; 36
2016; 66
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Snippet Objectives To compare existing algorithms for classifying screening vs diagnostic colonoscopies and to quantify the increase in screening colonoscopy rates...
To compare existing algorithms for classifying screening vs diagnostic colonoscopies and to quantify the increase in screening colonoscopy rates when Medicare...
Objectives: To compare existing algorithms for classifying screening vs diagnostic colonoscopies and to quantify the increase in screening colonoscopy rates...
ObjectivesTo compare existing algorithms for classifying screening vs diagnostic colonoscopies and to quantify the increase in screening colonoscopy rates when...
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StartPage 839
SubjectTerms Affordable Care Act
Aged
algorithm
Algorithms
Changes
claims data
Classification
Colon
Colonoscopy
Colonoscopy - economics
Colonoscopy - statistics & numerical data
Colorectal Neoplasms - diagnosis
Cost analysis
Cost sharing
Cost Sharing - economics
Cost Sharing - statistics & numerical data
Diagnostic systems
Early Detection of Cancer - economics
Early Detection of Cancer - statistics & numerical data
Economic aspects
False Positive Reactions
Female
Government programs
Government regulation
Health Policy and Organizational Behavior
Humans
Insurance, Health, Reimbursement
Interpretation and construction
Laws, regulations and rules
Legal fees
Male
Medical economics
Medical law
Medical screening
Medicare
Patient Protection and Affordable Care Act - legislation & jurisprudence
Reimbursement
screening colonoscopy
Sensitivity
United States
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Title Changes in screening colonoscopy following Medicare reimbursement and cost‐sharing changes
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