Policies to Optimize Physician Billing Data in Academic Alternative Relationship Payment Plans: Practices and Perspectives IJPDS (2017) Issue 1, Vol 1:361 Proceedings of the IPDLN Conference (August 2016)

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Ceara Tess Cunningham
Hude Quan
Nathalie Jette
Tom Noseworthy
Carolyn Decoster
Published online: Apr 19, 2017


Changes in physician reimbursement policies may hinder the collection of billing claims in administrative databases. Various provincial academic alternative payment programs (APPs) use incentive- or punitive-based tools to motivate physicians to submit billing claims called shadow billings; however, these incentives are not well documented in the literature. We conducted a nation-wide survey and semi-structured face-to-face interviews in Alberta, Canada to determine existing policies and guidelines for incentivizing and promoting physician billing practices.

Mail and online surveys were sent out to academic department head physicians in the following provinces: British Columbia, Alberta, Saskatchewan, Manitoba, Ontario, New Brunswick, Prince Edward Island and Newfoundland and Labrador. Face-to-face interviews were conducted in the province of Alberta with managers, government stakeholders, and physicians/administrators from academic APPs and Fee-for-Service plans. Face-to-face interviews and responses by mail and email submission were summarized using content analysis grouped by question type.

In total, there were 46 respondents (15 interviews, 26 mail/online). Content analysis revealed three primary perspectives, grouped at the level of individual physician, academic, and government. Across all of these unique perspectives, three primary themes emerged: 1) governance; 2) accountability; and 3) funding. Within these themes, findings were categorized as either (a) instruments or tools to promote physician billing in AAPPs; (b) enabling factors to support physician billing in AAPPs; and, (c) constraining factors impeding physician billing in AAPPs.

According to the majority of our respondents, financial disincentives (i.e. income at risk, financial clawbacks) appear to be most effective as a mechanism to motivate physicians within an academic APP to submit their billings. However, key barriers to successful implementation and delivery of academic APPs include a lack of alignment between government stakeholders, academic leadership and APP physician members and differences in the organizational and accountability structures of APP plans between academic facilities. It is necessary in moving forward to achieve commonly defined standards and frameworks between the various APP models across provinces and academic institutions.


The complex interaction between lifestyle, behaviours, genetic factors and the social and physical environment have a fundamental role in modulating risk and/ or progression of health outcomes, especially cancer. To address this complexity, access to large-scale cohorts involving hundreds of thousands of participants and collecting comprehensive and valuable information are required. In the real world however, attaining adequate statistical power presents a major challenge.

Retrospective data harmonization and integration across multiple cohort studies has been shown to be an effective analytical approach to attaining statistical power, with the potential to support population health research and policy related questions and improve our understanding of the complex factors affecting health outcomes.


Large cohorts, with at least 50,000 participants, initiated in countries all over the world, focused on innovative research on cancer and other chronic diseases were invited to participate in this retrospective data harmonization initiative. Cohorts shared their comprehensive metadata related to their study content and design. Almost 150 variables, selected for their relevance to be part of a generic set of information useful for a broad range of research question, were assessed for their harmonization potential and made available on an online searchable study catalogue. Lastly, a proof of concept research question on the retrospective harmonized data was conducted and aimed to investigate methods to analyze individual patient data from multiple studies by studying the determinants associated with age at menopause.


Eight cohorts from multiple countries shared their comprehensive metadata related to their study content and design, resulting in over 2 million study participants. Of the 150 potential variables, the majority of them were harmonizable for co-analysis. The proof of concept research question, applied to these variables generated interesting results, widely supported by other research on this topic, found in the literature. This work demonstrates the value of retrospective data harmonization and integration to be an effective analytical approach to attaining statistical power.

The searchable study catalogue, available online for researchers to use in their own international research projects offers a new innovative tool for potential co-analysis of similar measures collected by separate cohort studies.


Retrospective harmonization offers an innovative approach to optimize use of existing research data with increased statistical power.

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