Offsetting Patient-Centered Medical Homes Investment Costs Through Per-Member-Per-Month or Medicare Merit-based Incentive Payment System Incentive Payments.
Offsetting Patient-Centered Medical Homes Investment Costs Through Per-Member-Per-Month or Medicare Merit-based Incentive Payment System Incentive Payments.
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通过按会员每月或基于医疗保险绩效的激励支付系统激励付款来抵消以患者为中心的医疗之家的投资成本。
DOI：
10.1097/jac.0000000000000224
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发表时间：
2018
期刊：
影响因子：
--
通讯作者：
Fleming,NeilS
中科院分区：
文献类型：
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作者：
daGraca,Briget;Ogola,GeraldO;Fullerton,Cliff;McCorkle,Russell;Fleming,NeilS
初级保健实践成为以患者为中心的医疗之家(PCMH)，以改善护理。然而，投资成本和抵消这些成本的机会对这一决定至关重要。我们研究了通过商业支付者按会员每月(PMPM)支付和基于Medicare Merit的激励支付系统(MIPS)对一个网络进行的潜在补偿，该网络在4年内花费了4 818 260美元，获得并续签了57个诊所的PCMH认可。PMPM的支付金额从3.37美元到8.98美元不等，要想实现盈亏平衡，需要覆盖该网络中每位医生1645名商业保险患者中的2.4%到6.4%，同时将MIPS奖励付款的一半用于2016年每位医生平均196812美元的平均2016年联邦医疗保险报销，结果表明，到2022年，他们将超过PCMH成本。
Primary care practices become patient-centered medical homes (PCMHs) to improve care. However, investment costs and opportunities to offset those costs are critical to the decision. We examined potential offsets through commercial payer per-member-per-month (PMPM) payments and the Medicare Merit-based Incentive Payment System (MIPS) for a network that spent $4 818 260 over 4 years obtaining and renewing PCMH recognition for 57 practices. With PMPM payments of $3.37 to $8.98,“breakeven” requires that 2.4% to 6.4% of the network's 1645 commercially insured patients per physician be covered, while applying MIPS incentive payments of half the maximum available each year to the network's average 2016 Medicare reimbursement of $196 812 per physician showed they would exceed PCMH costs by 2022.