Home Health Care Quality, Its Costs and Implications for Home Health Value-Based Purchasing.
Home Health Care Quality, Its Costs and Implications for Home Health Value-Based Purchasing.
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DOI：
10.1177/1077558720974528
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发表时间：
2022-03
期刊：
影响因子：
--
通讯作者：
Ettner SL
中科院分区：
文献类型：
--
作者：
Mukamel DB;Ladd H;Nuccio E;Zinn JS;Sorkin DH;Ettner SL
家庭健康基于价值的采购（HHVBP）示范项目包含了一个旨在激励高质量护理和质量改进的支付公式，预计将在2022年示范项目结束后成为一项全国性项目。本研究调查了成本与若干质量维度之间的关系，为HHVBP政策提供参考。使用医疗保险成本报告、OASIS和家庭健康比较全国7,673家家庭健康机构的数据，我们用质量的工具变量估计成本函数。估计的净边际成本因综合质量度量、基线质量和机构规模而异。对于五种综合质量措施中的四种，低质量机构的净边际成本为负，这表明质量改进是这种机构类型的成本节约。由于净边际成本的大小与HHVBP计划的支付激励是相称的，因此在设计HHVBP激励时应考虑到最大化其有效性。
The Home Health Value-based Purchasing (HHVBP) demonstration, incorporating a payment formula designed to incentivize both high quality care and quality improvement, is expected to become a national program after 2022, when the demonstration ends. This study investigated the relationship between costs and several quality dimensions, to inform HHVBP policy. Using Medicare cost reports, OASIS and Home Health Compare data for 7,673 home health agencies nationally, we estimated cost functions with instrumental variables for quality. The estimated net marginal costs varied by composite quality measure, baseline quality, and agency size. For four of the five composite quality measures the net marginal cost was negative for low quality agencies, suggesting that quality improvement was cost saving for this agency type. As the magnitude of the net marginal cost is commensurate with the payment incentive planned for HHVBP it should be considered when designing the incentives for HHVBP, to maximize their effectiveness.
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