The PROMETHEUS Bundled Payment Experiment: Slow Start Shows Problems In Implementing New Payment Models
The PROMETHEUS Bundled Payment Experiment: Slow Start Shows Problems In Implementing New Payment Models
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DOI：
10.1377/hlthaff.2011.0784
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发表时间：
2011-11-01
期刊：
影响因子：
9.7
通讯作者：
Rosenthal, Meredith B.
中科院分区：
文献类型：
--
作者：
Hussey, Peter S.;Ridgely, M. Susan;Rosenthal, Meredith B.
按服务付费被指责为美国医疗保健系统中观察到的许多问题。2010年《平价医疗法案》中提出的领先替代支付模式之一是捆绑支付，它为患者在指定临床阶段所需的所有护理提供支付，而不是为每项离散服务付费。我们评估了PROMETHEUS Payment的初步“道路测试”，这是几个捆绑支付试点项目之一。该项目在执行方面面临重大挑战，截至2011年5月，三个试点地点均未执行合同或进行捆绑付款。试点项目的建立时间比预期的要长，主要是因为支付模式的复杂性，以及它建立在现有的按服务收费支付系统和医疗保健的其他复杂性基础上。参与者继续看到捆绑支付模式的前景和价值，但试点结果表明，这一改革和其他支付改革的预期效益可能需要时间和相当大的努力才能实现。
Fee-for-service payment is blamed for many of the problems observed in the US health care system. One of the leading alternative payment models proposed in the Affordable Care Act of 2010 is bundled payment, which provides payment for all of the care a patient needs over the course of a defined clinical episode, instead of paying for each discrete service. We evaluated the initial "road test" of PROMETHEUS Payment, one of several bundled payment pilot projects. The project has faced substantial implementation challenges, and none of the three pilot sites had executed contracts or made bundled payments as of May 2011. The pilots have taken longer to set up than expected, primarily because of the complexity of the payment model and the fact that it builds on the existing fee-for-service payment system and other complexities of health care. Participants continue to see promise and value in the bundled payment model, but the pilot results suggest that the desired benefits of this and other payment reforms may take time and considerable effort to materialize.