Capitated versus fee-for-service reimbursement and quality of care for chronic disease: a US cross-sectional analysis.
Capitated versus fee-for-service reimbursement and quality of care for chronic disease: a US cross-sectional analysis.
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DOI：
10.1186/s12913-021-07313-3
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发表时间：
2022-01-04
影响因子：
2.8
通讯作者：
Ibrahim S
中科院分区：
文献类型：
--
作者：
Tummalapalli SL;Estrella MM;Jannat-Khah DP;Keyhani S;Ibrahim S
即将到来的替代支付模式，初级保健优先（PCF）和肾脏护理选择（KCC）纳入慢性疾病管理的资本支付。先前对慢性疾病管理的资本化支付效果的研究显示了不同的结果。我们评估了病人、医生和以人头制为主要收入的实践特点，并评估了人头制报销与慢性病护理质量的关系。我们对美国国家门诊医疗调查（NAMCS）中高血压、糖尿病或慢性肾脏疾病（CKD）患者的就诊情况进行了横断面分析。我们的预测因子是实践报销类型，分类为1)大多数人头，2)大多数FFS，或3)其他报销组合。结果是高血压控制、糖尿病控制、血管紧张素转换酶抑制剂或血管紧张素受体阻滞剂（ACEi/ARB）使用和他汀类药物使用的质量指标。大约9%的访问是在大部分资本收入的诊所。定额实践,与FFS和其他实践相比,访问频率较低(3.7 vs 5.2和5.2,p = 0.006),更有可能是位于西部的人口普查区域(55% vs 18%比17%,p < 0.001),不太可能单独练习(21% vs 37%比35%,p = 0.005),更可能是由保险公司、健康计划或HMO (24% vs 13%比13%,p = 0.033),和更可能有私人保险(43% vs . 25%和19%,P = 0.004)和管理医疗支付（69% vs. 23% vs. 26%, P < 0.001）是收入的主要部分。控制高血压、控制糖尿病、ACEi/ARB使用和他汀类药物使用的患病率在实践报销类型中均为次优。在多变量模型中，调整患者、医生和执业特征后，累计报销与高血压、糖尿病或CKD质量指标的差异无关。在患者、医生和实践特征方面，大部分人头收入的实践与FFS和其他实践存在很大差异，但与一致的质量差异无关。我们的研究结果通过实践报销构成建立了慢性病护理质量绩效的基线估计，为即将到来的支付模式中的慢性病护理提供了信息。在线版本包含补充材料，可在10.1186/s12913-021-07313-3获得。
Upcoming alternative payment models Primary Care First (PCF) and Kidney Care Choices (KCC) incorporate capitated payments for chronic disease management. Prior research on the effect of capitated payments on chronic disease management has shown mixed results. We assessed the patient, physician, and practice characteristics of practices with capitation as the majority of revenue, and evaluated the association of capitated reimbursement with quality of chronic disease care. We performed a cross-sectional analysis of visits in the United States’ National Ambulatory Medical Care Survey (NAMCS) for patients with hypertension, diabetes, or chronic kidney disease (CKD). Our predictor was practice reimbursement type, classified as 1) majority capitation, 2) majority FFS, or 3) other reimbursement mix. Outcomes were quality indicators of hypertension control, diabetes control, angiotensin-converting enzyme inhibitor or angiotensin receptor blocker (ACEi/ARB) use, and statin use. About 9% of visits were to practices with majority capitation revenue. Capitated practices, compared with FFS and other practices, had lower visit frequency (3.7 vs. 5.2 vs. 5.2, p = 0.006), were more likely to be located in the West Census Region (55% vs. 18% vs. 17%, p < 0.001), less likely to be solo practice (21% vs. 37% vs. 35%, p = 0.005), more likely to be owned by an insurance company, health plan or HMO (24% vs. 13% vs. 13%, p = 0.033), and more likely to have private insurance (43% vs. 25% vs. 19%, p = 0.004) and managed care payments (69% vs. 23% vs. 26%, p < 0.001) as the majority of revenue. The prevalence of controlled hypertension, controlled diabetes, ACEi/ARB use, and statin use was suboptimal across practice reimbursement types. Capitated reimbursement was not associated with differences in hypertension, diabetes, or CKD quality indicators, in multivariable models adjusting for patient, physician, and practice characteristics. Practices with majority capitation revenue differed substantially from FFS and other practices in patient, physician, and practice characteristics, but were not associated with consistent quality differences. Our findings establish baseline estimates of chronic disease quality of care performance by practice reimbursement composition, informing chronic disease care delivery within upcoming payment models. The online version contains supplementary material available at 10.1186/s12913-021-07313-3.
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影响因子：
9.7
作者：
Miller, RH;Luft, HS
通讯作者：
Luft, HS
DOI：
10.1056/nejmsa2032271
发表时间：
2021-06-10
期刊：
The New England journal of medicine
影响因子：
--
作者：
Fang M;Wang D;Coresh J;Selvin E
通讯作者：
Selvin E
影响因子：
5.5
作者：
Levin, Adeera;Stevens, Paul E.
通讯作者：
Stevens, Paul E.
影响因子：
16.2
作者：
通讯作者：
--
影响因子：
105.7
作者：
Rundall, TG;Shortell, SM;Robinson, JC
通讯作者：
Robinson, JC