Identifying Poor-Performing Hospitals in the Medicare Hospital-Acquired Condition Reduction Program: An Assessment of Reliability
Identifying Poor-Performing Hospitals in the Medicare Hospital-Acquired Condition Reduction Program: An Assessment of Reliability
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DOI：
10.1097/jhq.0000000000000128
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发表时间：
2018-11-01
影响因子：
1.3
通讯作者：
Vaz, Christopher
中科院分区：
文献类型：
--
作者：
Soltoff, Samuel;Koenig, Lane;Vaz, Christopher
医疗保险和医疗补助服务中心（CMS）估计，医疗保险的医院获得性疾病减少计划（HAC-RP）将在2016财年减少3.64亿美元的医院支付。虽然观察员质疑某些HAC-RP措施的有效性，但对低绩效医院（最低四分位数）的确定和惩罚分配的可靠性的关注较少。本研究使用来自CMS医院比较的公开数据来模拟医院得分的一致性和在重复测量下的处罚分配，而每家医院的基本质量没有变化。仿真结果显示，在95%的置信水平上，64.0%的医院和40.6%的医院被罚款，与罚款阈值有统计学上的显著差异。与阈值有统计学差异的医院比例因所有制、教学状况的不同而有显著差异。床的大小和其他因素。模拟进一步表明，由于偶然的原因，18.0%的被处罚医院在重复测量时能够逃脱处罚。决策者应考虑对HAC-RP进行修改，以提高其可靠性。
Centers for Medicare and Medicaid Services (CMS) estimated that Medicare's Hospital-Acquired Condition Reduction Program (HAC-RP) would reduce hospital payments by $364 million in fiscal year 2016. Although observers have questioned the validity of certain HAC-RP measures, less attention has been paid to the determination of low-performing hospitals (bottom quartile) and the reliability of penalty assignment. This study used publicly available data from CMS's Hospital Compare to simulate the consistency of hospitals' scores and the assignment of penalties under repeated measurement with no change in each hospital's underlying quality. The simulation showed that 64.0% of all hospitals and 40.6% of hospitals subject to payment penalty are statistically significantly different from the penalty threshold at the 95% confidence level. The proportion of hospitals statistically different from the threshold showed significant variation by ownership status, teaching status. bed size, and other factors. The simulation further showed that due only to chance, 18.0% of penalized hospitals would escape penalty on repeated measurement. Policymakers should consider alterations to the HAC-RP to improve its reliability.