Effect of a Billing Code to Reimburse Nurse‐Supported Rheumatology Care on Health Care Costs and Access: An Interrupted Time Series Analysis

Abstract

ObjectiveThis study was undertaken to evaluate the impact of a Multidisciplinary Care Assessment (MCA) billing code on health system costs and access to care in British Columbia (BC).MethodsData on all people treated by rheumatologists in BC were obtained from five linked health administrative databases held by Population Data BC from April 1, 2006, to March 31, 2020. Rheumatologists were allocated to either the intervention (ever‐billers) or control group (never‐billers). For the intervention group, the index date was the month of first MCA code billing. For the control group the index data was imputed from intervention index dates. Our analysis focused on a 48‐month period (24 months pre‐ and post‐index date). We evaluated the impact on two cost (rheumatoid arthritis (RA)‐related costs; total health care costs) and access outcomes (rheumatology‐related visits per rheumatologist; days between rheumatology visits for RA‐patients) using an interrupted time‐series analysis.Results46 rheumatologists (31 intervention, 15 control) met our inclusion criteria. Introduction of the MCA was associated with a small but significant increase in RA‐related costs which, at two years, translates to a net absolute change of $9.66 per‐patient‐per‐month, but no statistically significant changes in total health care costs. There was no statistically significant change in the number of rheumatology‐related visits, but at two years there was a net absolute reduction in median days between rheumatologist visits for RA‐patients (6.3 days).ConclusionThe introduction of the MCA code was associated with a negligible increase in the RA‐related costs and an improvement in access to ongoing care for patients.