Opportunities for Savings in Risk Arrangements for Oncologic Care.
Opportunities for Savings in Risk Arrangements for Oncologic Care.
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DOI：
10.1001/jamahealthforum.2023.3124
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发表时间：
2023-09-01
期刊：
影响因子：
--
通讯作者：
Keating, Nancy L
中科院分区：
文献类型：
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作者：
Landon, Bruce E;Lam, Miranda B;Landrum, Mary Beth;McWilliams, J Michael;Meneades, Laurie;Wright, Alexi A;Keating, Nancy L
负责护理组织(ACO)和在特定地理区域运营的其他承担风险的组织有哪些机会通过指导患者在一个地区进行高效的肿瘤内科实践来实现节省？这项针对2名 739名 798患者的队列研究发现，不同医院转诊地区(HRR)的指导机会不同；实践次数最多的四分位数有10次或更多，但最低四分位数有3次或更少的肿瘤学实践。总体而言，市场中支出最高的四分位数业务的总支出比最低四分位数的高19%，而且随着时间的推移，业务级别的支出趋势持续存在。这些结果表明，ACOS和其他承担风险的组织(例如，签署的健康计划)可能有机会选择或推动转诊到许多当地市场的低支出肿瘤学实践。这项队列研究考察了负责任的护理组织和其他承担风险的组织通过引导患者到特定地理区域运营的有效医疗肿瘤学实践来实现节省的机会。随着美国加速采用通过责任护理组织(Acos)或联邦医疗保险优势(MA)等全球支付模式进行的替代支付，癌症护理的高支出是一个潜在的节省目标。量化ACO和在特定地理区域(医院转诊区域[HRR])运营的其他承担风险的组织通过指导患者进行有效的肿瘤内科实践来实现节省的程度。这项观察性研究包括2010至2018年间患有癌症的联邦医疗保险受益人的一系列横截面。对2021年8月至2023年3月的数据进行了分析。在对新诊断(事件)或预后不良的癌症患者进行索引访问后的一年内，按类别划分的总支出和支出。事件队列包括平均年龄74.0岁的1309名 825名患者；最常见的癌症类型是乳腺癌(21.4%)、肺癌(16.7%)和结直肠癌(10.0%)。预后不良的队列包括1 429 973(平均年龄72.7岁)，最常见的肿瘤类型是肺癌(26.6%)、淋巴瘤(11.7%)和白血病(7.3%)。不同市场的指导选择不同；最高的四分之一市场有10个或更多的肿瘤学实践，但最低的四分之一市场有3个或更少的肿瘤学实践。事故队列中的总支出(包括医疗保险D部分)从2009年至2010年的平均57 314美元增加到2016至2017年的66 028美元。在市场中，支出最高的四分位数的执业总支出比支出最低的四分位数高19%。住院支出是这两个时期最大的支出组成部分(分别为20 390美元和19 718美元)，其次是B部分(输液)化疗(8,022美元和11 699美元)。在实践层面上，第一年(2009年)和第二年(2010年)支出之间的相关性很高(所有类别的支出均为0.90，大多数为0.98)，但随着时间的推移，这种相关性逐渐减弱。这些结果表明，ACOS和其他承担风险的组织可能有机会选择或推动转诊到许多当地市场的低支出肿瘤学实践。
What are the opportunities for accountable care organizations (ACOs) and other risk-bearing organizations operating in a specific geographic area to achieve savings by steering patients to efficient medical oncology practices in a region? This cohort study of 2 739 798 patients found that opportunities for steering varied across hospital referral regions (HRRs); the top quartile HRR in number of practices had 10 or more practices, but the bottom quartile had 3 or fewer oncology practices. Overall, total spending in the highest spending quartile of practices in a market was 19% higher than in the lowest quartile, and practice-level spending tendencies were persistent over time. These results suggest that there may be opportunities for ACOs and other risk-bearing organizations (eg, capitated health plans) to select or drive referrals to lower-spending oncology practices in many local markets. This cohort study examines opportunities for accountable care organizations and other risk-bearing organizations to achieve savings by steering patients to efficient medical oncology practices operating in specific geographic areas. As the US accelerates adoption of alternative payment through global payment models such as Accountable Care Organizations (ACOs) or Medicare Advantage (MA), high spending for cancer care is a potential target for savings. To quantify the extent to which ACOs and other risk-bearing organizations operating in a specific geographic area (hospital referral region [HRR]) could achieve savings by steering patients to efficient medical oncology practices. This observational study included serial cross-sections of Medicare beneficiaries with cancer from 2010 to 2018. Data were analyzed from August 2021 to March 2023. Total spending and spending by category in the 1-year period following an index visit for a patient with newly diagnosed (incident) or poor-prognosis cancer. The incident cohort included 1 309 825 patients with a mean age of 74.0 years; the most common cancer types were breast (21.4%), lung (16.7%), and colorectal cancer (10.0%). The poor prognosis cohort included 1 429 973 (mean age, 72.7 years); the most common cancer types were lung (26.6%), lymphoma (11.7%), and leukemia (7.3%). Options for steering varied across markets; the top quartile market had 10 or more oncology practices, but the bottom quartile had 3 or fewer oncology practices. Total spending (including Medicare Part D) in the incident cohort increased from a mean of $57 314 in 2009 to 2010 to $66 028 in 2016 to 2017. Within markets, total spending for practices in the highest spending quartile was 19% higher than in the lowest quartile. Hospital spending was the single largest component of spending in both time periods ($20 390 and $19 718, respectively) followed by Part B (infused) chemotherapy ($8022 and $11 699). Correlations in practice-level spending between the first-year (2009) and second-year (2010) spending were high (>0.90 in all categories with most >0.98), but these attenuated over time. These results suggest there may be opportunities for ACOs and other risk-bearing organizations to select or drive referrals to lower-spending oncology practices in many local markets.
在新诊断的癌症后，对医学肿瘤学家，外科医生或辐射肿瘤学家的护理的归因评估。
影响因子：
13.8
作者：
Gondi S;Wright AA;Landrum MB;Meneades L;Zubizarreta J;Chernew ME;Keating NL
通讯作者：
Keating NL