Estimating the completeness of physician billing claims for diabetes case ascertainment: a multiprovince investigation

• Published in: Health Promotion and Chronic Disease Prevention in Canada
• Main Authors: Joellyn Ellison, Yong Jun Gao, Kimberley Hutchings, Sharon Bartholomew, Hélène Gardiner, Lin Yan, Karen A. M. Phillips, Aakash Amatya, Maria Greif, Ping Li, Yue Liu, Yao Nie, Josh Squires, J. Michael Paterson, Rolf Puchtinger, Lisa Marie Lix
• Format: Article in Journal/Newspaper
• Language: English; French
• Published: Public Health Agency of Canada 2023
• Subjects: Medicine (General); R5-920; Billing; Newfoundland; Prince Edward Island
• Online Access: https://doi.org/10.24095/hpcdp.43.12.03; https://doaj.org/article/25c53ad7489d4578ad1ce0bc68be2ced

IntroductionPrevious research has suggested that how physicians are paid may affect the completeness of billing claims for estimating chronic disease. The purpose of this study is to estimate the completeness of physician billings for diabetes case ascertainment. MethodsWe used administrative data from eight Canadian provinces covering the period 1 April 2014 to 31 March 2016. The patient cohort was stratified into two mutually exclusive groups based on their physician remuneration type: fee-for-service (FFS), for those paid only on that basis; and non-fee-for-service (NFFS). Using diabetes prescription drug data as our reference data source, we evaluated whether completeness of disease case ascertainment varied with payment type. Diabetes incidence rates were then adjusted for completeness of ascertainment. ResultsThe cohort comprised 86 110 patients. Overall, equal proportions received their diabetes medications from FFS and NFFS physicians. Overall, physician payment method had little impact upon the percentage of missed diabetes cases (FFS, 14.8%; NFFS, 12.2%). However, the difference in missed cases between FFS and NFFS varied widely by province, ranging from −1.0% in Nova Scotia to 29.9% in Newfoundland and Labrador. The difference between the observed and adjusted disease incidence rates also varied by province, ranging from 22% in Prince Edward Island to 4% in Nova Scotia. ConclusionThe difference in the loss of cases by physician remuneration method varied across jurisdictions. This loss may contribute to an underestimation of disease incidence. The method we used could be applied to other chronic diseases for which drug therapy could serve as reference data source.