Grant: Operating Grant

Physicians are compensated based on the services provided to patients using a system known as fee-for-services (FFS). Each diagnosis, service or procedure is recorded using this system from which the physician is paid and the patient file is updated, allowing for relatively accurate tracking of physician billing and patient care. Recently an alternative payment or renumeration system has gained acceptance and membership known as the alternative payment plan (APP) or 'shadow billing'. Shadow billing compensates physicians not based on services provided but rather on hours or days worked. Initial shadow billing investigations indicate the data may not be as accurate as the FFS method because physicians are not compensated for their time spent shadow billing. As a direct result, this can affect not only the administrative data quality, but also decision making because the data are commonly used for healthcare system performance evaluation and healthcare resource planning. This study will determine the validity of shadow billing by analysing claims before and after APP acceptance. In addition, a random selection of the physicians from the group will have their chart data compared with their claims data. This study will determine the appropriate shadow billing corrections to accurately reflect shadow billing as it relates to quality of care assessment.