Implications for ACOs of variations in spending growth.
Implications for ACOs of variations in spending growth.
复制标题
支出增长变化对 ACO 的影响。
DOI：
10.1056/nejmp1202004
复制
发表时间：
2012
期刊：
影响因子：
--
通讯作者：
Song,Zirui
中科院分区：
文献类型：
--
作者：
McWilliams,JMichael;Song,Zirui
Medicare Pioneer和Shared Savings Accountable Care Organization（ACO）计划为医疗保健提供者组织提供了与Medicare签订合同的机会，根据合同，他们承担财务风险，并因以较低成本提供高质量的护理而获得奖励。在这两个项目中，ACO的支出目标将根据指定受益人群体的基线医疗保险支出来确定，并根据国家医疗保险支出的平均增长来预测。根据Medicare共享储蓄计划的规则，1使用国家支出增长因素的理由是对高支出和快速支出增长地区的组织施加更大的下行压力，同时允许低支出和缓慢增长地区的更多储蓄，以支持组织对基础设施的投资。然而，由于Medicare支出水平与增长率在地理上不相关，在许多高支出领域，国家支出增长超过地方增长，在许多低支出领域，国家支出增长低于地方增长。[2]例如，根据达特茅斯阿特拉斯对2008年每个受益人的医疗保险支出和2007 - 2008年增长率的估计，以下四个类别中的每一个都描述了美国306个医院转诊地区（HRR）中至少15%的地区：低支出、低增长;低支出、高增长;高支出、低增长;高支出、高增长（见表）。43%的人力资源报告属于中间两类，支出水平和增长率不一致。
The Medicare Pioneer and Shared Savings Accountable Care Organization (ACO) programs have offered health care provider organizations the opportunity to enter into contracts with Medicare under which they assume financial risk and are rewarded for providing highquality care at lower cost. In both programs, spending targets for ACOs will be determined on the basis of baseline Medicare spending for assigned populations of beneficiaries, projected forward by average increases in national Medicare spending. According to the rules for the Medicare Shared Savings Program, 1 the rationale for using national spending growth factors is to exert greater downward pressure on organizations in regions with high spending and rapid spending growth, while permitting greater savings in regions of low spending and slow growth to support organizational investments in infrastructure.Because Medicare spending levels are not geographically correlated with growth rates, however, national spending growth exceeds local growth in many high-spending areas and is lower than local growth in many low-spending areas. 2 For example, according to Dartmouth Atlas estimates of per-beneficiary Medicare spending in 2008 and growth rates from 2007 to 2008, each of the following four categories described at least 15% of the 306 US hospitalreferral regions (HRRs): low-spending, low-growth; low-spending, high-growth; highspending, low-growth; and high-spending, high-growth (see table). Forty-three percent of HRRs were in the middle two categories with discordant spending levels and growth rates.