title: Effect of physician specialist alternative payment plans on administrative health data in Calgary: a validation study.
abstract: BACKGROUND
  There are concerns that alternate payment plans for physicians may be associated with erosion of data quality, given that physicians are paid regardless of whether claims are submitted. Our objective was to determine the proportion of claims submitted by physician specialists using fee-for-service and alternative payment plans, and to identify and compare the validity of information coded in physician billing claims submitted by these specialists in Calgary.
  
  
  METHODS
  We conducted a survey of physician specialists to determine their plan status and obtained consent to use physicians' claims data from 4 acute care hospitals in Calgary. Inpatient and emergency department services were identified from the Discharge Abstract Database for Alberta (Canadian Institute for Health Information) and the Alberta Ambulatory Care Classification System database. We linked services to claims by Alberta physicians from 2002 to 2009 by using unique patient and physician identifiers. After identifying the proportion of claims submitted, we reviewed inpatient charts to determine the completeness of submissions as defined by positive predictive value.
  
  
  RESULTS
  Of 182 physicians who responded to the survey, 94 (51.6%) used fee-for-service plans exclusively and 51 (28.0%) used alternative payment plans exclusively. Overall completeness of physician submissions for claims was 91.8% for physicians using fee-for-service plans and 90.0% for physicians using alternative payment plans. Submission rate varied by medical specialty (surgery: 92.4% for fee for service v. 88.6% for alternative payment; internal medicine: 94.1% v. 91.3%; neurology: 95.1% v. 91.0%; and pediatrics: 95.1% v. 89.3%). Among claims submitted, the physician accuracies for billing of medical conditions were 87.8% for fee-for-service and 85.0% for alternative payment.
  
  
  CONCLUSIONS
  Overall submission rates and accuracy in recording diagnoses by physicians who used both plans were high. These findings show that the implementation of alternative payment plan programs in Alberta may not have an impact on the quality of physician claims data.
authors.affiliation: Department of Community Health Sciences (Cunningham, Noseworthy, Quan), University of Calgary; Departments of Clinical Neurosciences and Hotchkiss Brain Institute and Community Health Sciences and Institute for Public Health (Jetté), University of Calgary; Data Integration, Measurement and Reporting (Li, DeCoster), Alberta Health Services; Faculty of Nursing (Dhanoa), University of Calgary; Departments of Medicine and Community Health Sciences (Hemmelgarn, Dixon, Ghali), University of Calgary; Departments of Community Health Sciences and Psychiatry (Beck), University of Calgary; Department of Pediatric Nephrology (Samuel), University of Calgary, Calgary, Alta.
authors.forename: Ceara Tess
authors.initials: CT
authors.lastname: Cunningham
authors.affiliation: Department of Community Health Sciences (Cunningham, Noseworthy, Quan), University of Calgary; Departments of Clinical Neurosciences and Hotchkiss Brain Institute and Community Health Sciences and Institute for Public Health (Jetté), University of Calgary; Data Integration, Measurement and Reporting (Li, DeCoster), Alberta Health Services; Faculty of Nursing (Dhanoa), University of Calgary; Departments of Medicine and Community Health Sciences (Hemmelgarn, Dixon, Ghali), University of Calgary; Departments of Community Health Sciences and Psychiatry (Beck), University of Calgary; Department of Pediatric Nephrology (Samuel), University of Calgary, Calgary, Alta.
authors.forename: Nathalie
authors.initials: N
authors.lastname: Jetté
authors.affiliation: Department of Community Health Sciences (Cunningham, Noseworthy, Quan), University of Calgary; Departments of Clinical Neurosciences and Hotchkiss Brain Institute and Community Health Sciences and Institute for Public Health (Jetté), University of Calgary; Data Integration, Measurement and Reporting (Li, DeCoster), Alberta Health Services; Faculty of Nursing (Dhanoa), University of Calgary; Departments of Medicine and Community Health Sciences (Hemmelgarn, Dixon, Ghali), University of Calgary; Departments of Community Health Sciences and Psychiatry (Beck), University of Calgary; Department of Pediatric Nephrology (Samuel), University of Calgary, Calgary, Alta.
authors.forename: Bing
authors.initials: B
authors.lastname: Li
authors.affiliation: Department of Community Health Sciences (Cunningham, Noseworthy, Quan), University of Calgary; Departments of Clinical Neurosciences and Hotchkiss Brain Institute and Community Health Sciences and Institute for Public Health (Jetté), University of Calgary; Data Integration, Measurement and Reporting (Li, DeCoster), Alberta Health Services; Faculty of Nursing (Dhanoa), University of Calgary; Departments of Medicine and Community Health Sciences (Hemmelgarn, Dixon, Ghali), University of Calgary; Departments of Community Health Sciences and Psychiatry (Beck), University of Calgary; Department of Pediatric Nephrology (Samuel), University of Calgary, Calgary, Alta.
authors.forename: Ravneet Robyn
authors.initials: RR
authors.lastname: Dhanoa
authors.affiliation: Department of Community Health Sciences (Cunningham, Noseworthy, Quan), University of Calgary; Departments of Clinical Neurosciences and Hotchkiss Brain Institute and Community Health Sciences and Institute for Public Health (Jetté), University of Calgary; Data Integration, Measurement and Reporting (Li, DeCoster), Alberta Health Services; Faculty of Nursing (Dhanoa), University of Calgary; Departments of Medicine and Community Health Sciences (Hemmelgarn, Dixon, Ghali), University of Calgary; Departments of Community Health Sciences and Psychiatry (Beck), University of Calgary; Department of Pediatric Nephrology (Samuel), University of Calgary, Calgary, Alta.
authors.forename: Brenda
authors.initials: B
authors.lastname: Hemmelgarn
authors.affiliation: Department of Community Health Sciences (Cunningham, Noseworthy, Quan), University of Calgary; Departments of Clinical Neurosciences and Hotchkiss Brain Institute and Community Health Sciences and Institute for Public Health (Jetté), University of Calgary; Data Integration, Measurement and Reporting (Li, DeCoster), Alberta Health Services; Faculty of Nursing (Dhanoa), University of Calgary; Departments of Medicine and Community Health Sciences (Hemmelgarn, Dixon, Ghali), University of Calgary; Departments of Community Health Sciences and Psychiatry (Beck), University of Calgary; Department of Pediatric Nephrology (Samuel), University of Calgary, Calgary, Alta.
authors.forename: Tom
authors.initials: T
authors.lastname: Noseworthy
authors.affiliation: Department of Community Health Sciences (Cunningham, Noseworthy, Quan), University of Calgary; Departments of Clinical Neurosciences and Hotchkiss Brain Institute and Community Health Sciences and Institute for Public Health (Jetté), University of Calgary; Data Integration, Measurement and Reporting (Li, DeCoster), Alberta Health Services; Faculty of Nursing (Dhanoa), University of Calgary; Departments of Medicine and Community Health Sciences (Hemmelgarn, Dixon, Ghali), University of Calgary; Departments of Community Health Sciences and Psychiatry (Beck), University of Calgary; Department of Pediatric Nephrology (Samuel), University of Calgary, Calgary, Alta.
authors.forename: Cynthia A
authors.initials: CA
authors.lastname: Beck
authors.affiliation: Department of Community Health Sciences (Cunningham, Noseworthy, Quan), University of Calgary; Departments of Clinical Neurosciences and Hotchkiss Brain Institute and Community Health Sciences and Institute for Public Health (Jetté), University of Calgary; Data Integration, Measurement and Reporting (Li, DeCoster), Alberta Health Services; Faculty of Nursing (Dhanoa), University of Calgary; Departments of Medicine and Community Health Sciences (Hemmelgarn, Dixon, Ghali), University of Calgary; Departments of Community Health Sciences and Psychiatry (Beck), University of Calgary; Department of Pediatric Nephrology (Samuel), University of Calgary, Calgary, Alta.
authors.forename: Elijah
authors.initials: E
authors.lastname: Dixon
authors.affiliation: Department of Community Health Sciences (Cunningham, Noseworthy, Quan), University of Calgary; Departments of Clinical Neurosciences and Hotchkiss Brain Institute and Community Health Sciences and Institute for Public Health (Jetté), University of Calgary; Data Integration, Measurement and Reporting (Li, DeCoster), Alberta Health Services; Faculty of Nursing (Dhanoa), University of Calgary; Departments of Medicine and Community Health Sciences (Hemmelgarn, Dixon, Ghali), University of Calgary; Departments of Community Health Sciences and Psychiatry (Beck), University of Calgary; Department of Pediatric Nephrology (Samuel), University of Calgary, Calgary, Alta.
authors.forename: Susan
authors.initials: S
authors.lastname: Samuel
authors.affiliation: Department of Community Health Sciences (Cunningham, Noseworthy, Quan), University of Calgary; Departments of Clinical Neurosciences and Hotchkiss Brain Institute and Community Health Sciences and Institute for Public Health (Jetté), University of Calgary; Data Integration, Measurement and Reporting (Li, DeCoster), Alberta Health Services; Faculty of Nursing (Dhanoa), University of Calgary; Departments of Medicine and Community Health Sciences (Hemmelgarn, Dixon, Ghali), University of Calgary; Departments of Community Health Sciences and Psychiatry (Beck), University of Calgary; Department of Pediatric Nephrology (Samuel), University of Calgary, Calgary, Alta.
authors.forename: William A
authors.initials: WA
authors.lastname: Ghali
authors.affiliation: Department of Community Health Sciences (Cunningham, Noseworthy, Quan), University of Calgary; Departments of Clinical Neurosciences and Hotchkiss Brain Institute and Community Health Sciences and Institute for Public Health (Jetté), University of Calgary; Data Integration, Measurement and Reporting (Li, DeCoster), Alberta Health Services; Faculty of Nursing (Dhanoa), University of Calgary; Departments of Medicine and Community Health Sciences (Hemmelgarn, Dixon, Ghali), University of Calgary; Departments of Community Health Sciences and Psychiatry (Beck), University of Calgary; Department of Pediatric Nephrology (Samuel), University of Calgary, Calgary, Alta.
authors.forename: Carolyn
authors.initials: C
authors.lastname: DeCoster
authors.affiliation: Department of Community Health Sciences (Cunningham, Noseworthy, Quan), University of Calgary; Departments of Clinical Neurosciences and Hotchkiss Brain Institute and Community Health Sciences and Institute for Public Health (Jetté), University of Calgary; Data Integration, Measurement and Reporting (Li, DeCoster), Alberta Health Services; Faculty of Nursing (Dhanoa), University of Calgary; Departments of Medicine and Community Health Sciences (Hemmelgarn, Dixon, Ghali), University of Calgary; Departments of Community Health Sciences and Psychiatry (Beck), University of Calgary; Department of Pediatric Nephrology (Samuel), University of Calgary, Calgary, Alta.
authors.forename: Hude
authors.initials: H
authors.lastname: Quan