Health Check Guidelines and Billing for Family Physicians Caring for Adults with Intellectual and Developmental Disabilities

OBJECTIVE:To examine the degree to which Canadian consensus guideline recommendations for annual comprehensive preventive care assessments of adults with intellectual and developmental disabilities (IDD) are being taken up by Nova Scotia family physicians since the introduction of incentive billing codes; and to discuss the importance of complete physical examinations for this patient population, extra time needed in clinic encounters, and challenges for practitioners providing care.DESIGN:Analysis of family physicians' billing of codes 03.04C and 03.03E from April 2012 to December 2016.SETTING:Nova Scotia.PARTICIPANTS:Family physicians.MAIN OUTCOME MEASURES:Number of billings through fee-for-service and alternative payment plans, and number of providers who used these fee codes.RESULTS:Analysis yielded 3 key results. Use of incentivized billing codes for adult IDD visits and complete examinations in Nova Scotia has steadily increased for patients since the introduction of the modified codes. There is measurable uptake of the IDD adult visit code in total numbers and numbers of providers billing the code. There is poor uptake of the complete examination code.CONCLUSION:Enhanced billing codes will provide Nova Scotia family physicians with an incentive to employ the newly revised 2018 Canadian consensus guidelines in the care of adults with IDDs. With continued discussion and promotion of annual physical examinations for patients with IDD, more patients and caregivers might make this proactive care item a priority.